The knee is a complex hinge joint. A patellofemoral joint replacement becomes necessary once all medical treatments have been exhausted. The diseased part of the knee joint is usually isolated to behind the patella (kneecap) and the groove it tracks over (trochlea) and it becomes so badly damaged that, in spite of painkillers, it causes significant pain which interferes with your quality of life. The purpose of surgery is to relieve pain and therefore improve function and quality of life.
Patellofemoral joint replacement is normally considered when the joint cartilage is worn down to bone, with relative preservation of the rest of the joint. It is becoming an increasingly popular procedure with good results. Surgery either takes place under a general anaesthetic or with an anaesthetic injection in the back (spinal anaesthetic) with or without sedation. The operation usually takes between one and one and a half hours. It usually involves resurfacing the back of the patella with a plastic ‘button’ and the tochlear groove with a cemented metal component.
My patellofemoral replacement of choice is the LCS patellofemoral replacement. I normally inject the joint capsule with local anaesthetic and adrenaline, which enables post-operative rehabilitation to start on the day of surgery.
Hospital stay is usually 2 - 3 days and it usually takes 2 - 3 months to get over the procedure and return to normal activities, although this is variable upon individual circumstances. Rehabilitation starts on the day of surgery. The physiotherapist will advise you when to do this and will provide you with a programme of activities to perform in hospital and when you go home. Long term recovery and function is dependent upon not only the quality of the initial surgery but also the amount of work done by the patient in the rehabilitation phase.
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