Surgical treatment of knee osteoarthritis focusing on the patellofemoral joint

Abstract

Background: Surgical management of the osteoarthritic knee joint consists of osteotomies such as a high tibial osteotomy (HTO), uni-compartmental knee arthroplasty (UKA), and total knee arthroplasty (TKA). These surgeries mainly treat the tibiofemoral joint but can also have an impact on the patellofemoral (PF) joint. These changes in PF joint can affect the surgical outcome.Current Concepts: PF joint problems are relative contraindications in UKA. However, recent studies have reported that these problems do not markedly affect the result of UKA. During HTO, the patella height and tracking can change, affecting the PF joint problem. The effect of the PF joint can be minimized through various methods of closing wedge HTO or modified opening wedge (OW) HTO, such as retro-tubercular biplanar OWHTO. However, this method is controversial regarding its impact on clinical outcomes. In TKA, pain caused by PF joint problems can be reduced using techniques such as patella resurfacing, patelloplasty, and denervation; however, there is no clear consensus.Discussion and Conclusion: The surgical treatment of degenerative knee osteoarthritis has an impact on the PF joint, which can affect the outcome of surgery and vice versa. However, these impacts only occasionally cause clinical difference. Conclusively, these surgeries should be done by considering the PF joint because changes in the joint can affect the surgical outcome.