Patellofemoral Knee Replacement Procedure and Results

A knee replacement surgery is a procedure performed on people who have worn out the smooth cartilage lining of their knee joint, and are left with exposed bone-on-bone surfaces in the joint. This leads to pain and difficulty with activities that are seen in severe knee arthritis.

A model of the kneecap patella
Jeannot Olivet / Getty Images

Fortunately, knee replacement surgery, a procedure that replaces the worn out joint with a metal and plastic joint, is very successful at relieving pain and improving function. However, many people who have only limited arthritis of the knee are concerned about replacing the entire joint. There is another option for people who have arthritis limited to only a part of the knee joint, and that is called a partial knee replacement.

Partial Knee Replacement

A partial knee replacement, also called a unicompartmental knee replacement, means that only the most worn out part of the knee is being replaced. Generally, the knee is separated into three compartments, and therefore partial knee replacements are called unicompartmental knee replacements because they replace one compartment.

The three compartments are the inner side of the knee, the outer side of the knee, and the part under the kneecap. Most partial knee replacements replace the inner (medial) side or the outer (lateral) side of the knee. However, there are also partial knee replacement implants to replace the cartilage under the kneecap.

The compartment under the kneecap is commonly called the patellofemoral compartment. The undersurface of the kneecap is on one side, and the groove on the end of the thigh bone (the femur) is on the other side. The implants used to replace the patellofemoral compartment consist of a metal groove to fit on the end of the femur, and a plastic disc that attaches to the underside of the kneecap.

Patellofemoral Replacement Surgery and Recovery

During surgery to perform a patellofemoral knee replacement, the surgeon must create a surface on the underside of the kneecap and the groove on the end of the thigh bone to accommodate the artificial joint. The implanted joint is usually held in position with bone cement, similar to a standard total knee replacement.

The most important part of the surgery is to ensure that the kneecap will slide up and down in the groove on the end of the thigh bone normally. If this is not carefully addressed, the newly implanted partial knee replacement could wear out quickly.

Recovery after any type of partial knee replacement, including a patellofemoral replacement, is usually faster than a total knee replacement. The patient begins exercises to bend their knee immediately following surgery. While full weight can be placed on the knee, crutches or a walker are generally used for support for the first few weeks.

Results of Patellofemoral Replacement

It is difficult to know exactly how long a patellofemoral replacement will last. The implant designs have changed significantly in the last decade, in hopes that better implants will lead to better results.

Unfortunately, there is not much long-term data, and we are really left with shorter follow-up. In most of the studies have been done, 80% to 90% of patients will have good results in the first decade after patellofemoral replacement; whether or not they will hold up longer than that is not understood.

We also know that the most common reason that a patellofemoral replacement will not work well is not because of a problem with the implant, but rather a problem in the rest of the knee joint—the part that was not replaced. About 25% of patients will eventually require conversion of their partial patellofemoral replacement to a total knee replacement as a result of worsening arthritis in the other compartments of the knee.

This is why the patients who have the best results from patellofemoral knee replacement are those patients who have specific problems with their kneecap, such as a previous patella fracture or problems with patellar tracking. These conditions can lead to early wear of the cartilage under the kneecap.

Patients who have generalized knee arthritis, not as a result of a specific kneecap problem, tend to eventually require a full knee replacement.

A Word From Verywell

Patellofemoral knee replacement is uncommon compared to total knee replacement, or unicompartmental knee replacement of the medial compartment of the knee joint. Most people with patellofemoral arthritis have more widespread arthritis within the knee joint, making full knee replacement a more likely treatment. That said, there is a subset of patients who have arthritis that is isolated to the patellofemoral joint, who might benefit from this surgical procedure. Advancements in surgical techniques and implants available are making this a surgical option for people with severe arthritis under the kneecap.

2 Sources
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  1. American Academy of Orthopaedic Surgeons. Unicompartmental knee replacement.

  2. Pisanu G, Rosso F, Bertolo C, et al. Patellofemoral arthroplasty: Current concepts and review of the literatureJoints. 2017;5(4):237–245. doi:10.1055/s-0037-1606618

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.