Patellofemoral Arthroplasty: Evolving Indications, Technique, and Application in Younger Patients

Recent improvements in technique, implants, and patient selection have led to improved results from patellofemoral arthroplasty. There has been a resurgence in interest in this technique as a result, but it is important that strict criteria are applied when selecting appropriate patients. As failure has often been attributed to patellofemoral instability and tibiofemoral arthritis progression, thorough preoperative evaluation must confirm isolated patellofemoral disease and identify conditions that may adversely affect outcome. Meticulous surgical technique is also essential, especially regarding implant positioning, soft tissue management, and extensor alignment. More recent results have demonstrated that patellofemoral arthroplasty is actually best suited for younger patients, thus avoiding potential total knee replacement and preserving more natural knee kinematics.