Retropatellar replacement is a specialized procedure in knee arthroplasty that focuses on replacing the back of the kneecap (patella). This surgery may be necessary for patients with advanced osteoarthritis or other degenerative changes in the patellofemoral joint. In this blog, we will examine the benefits and risks of retropatellar replacement to provide patients with comprehensive information about this procedure.

What is Retropatellar Resurfacing?

The retropatellar replacement, also known as patellofemoral replacement, is a surgical procedure in which the back of the patella and the joint surface of the femur with which the patella is in contact are replaced with prosthetic components. This is often performed in patients suffering from patellofemoral osteoarthritis, a form of knee osteoarthritis that affects the back of the kneecap.

Indications for a retropatellar replacement

The most common indications for a retropatellar replacement are:

• Severe patellofemoral osteoarthritis: This affects the kneecap and the underlying bone, leading to significant pain and limited mobility.
• Lack of Improvement with Conservative Treatment: If conservative measures such as physical therapy, pain medication, and injections are not successful, surgical intervention may be necessary.
• Deformities and malalignments of the patella: These can be caused by injuries or degenerative processes and may require correction through a retropatellar replacement.

Benefits of Retropatellar Replacement

The retropatellar replacement offers numerous advantages over other treatment methods:

• Pain Relief: One of the main benefits is the significant reduction in pain often associated with patellofemoral osteoarthritis.
• Improved functionality: Patients often report improved mobility and an increase in overall knee function after surgery.
• Preservation of structures near the knee joint: Since the intervention specifically targets the patella, other parts of the knee remain unaffected, which can shorten the recovery time.
• Faster recovery: The minimally invasive techniques used in this procedure contribute to faster rehabilitation and a shorter hospital stay.
• High success rate: Studies show that most patients are satisfied with the results of retropatellar replacement and experience a long-term improvement in their quality of life.

Risks and complications of retropatellar replacement

As with any surgery, there are potential risks and complications associated with Retropatellar Resurfacing:

• Infections: Infections are a possible complication with any surgical intervention, but can be minimized with appropriate preventive measures.
• Prosthesis failure: In rare cases, the prosthesis can fail, requiring revision surgery.
• Blood clots: After surgery, there is a risk of blood clots forming, particularly in the legs (deep vein thrombosis).
• Instability of the Patella: Inadequate adjustment of the prosthesis can lead to instability or malalignment of the patella.
• Pain and limited mobility: Although most patients experience pain relief, some may continue to have pain and limited mobility.

The Surgical Procedure

Retropatellar Resurfacing is performed under general anesthesia or spinal anesthesia. The procedure involves several steps:

• Access to the knee joint: The surgeon makes an incision over the kneecap to access the patella and the underlying bone.
• Removal of damaged surfaces: The damaged cartilage and bone parts of the patella and femur are removed.
• Adjustment of Prosthetic Components: The prosthetic components are adjusted and secured. Care is taken to preserve the natural anatomy of the knee.
• Wound closure: After placement of the prosthesis, the wound is closed and a dressing is applied.

Rehabilitation and Aftercare

Rehabilitation after retropatellar replacement is crucial for the success of the operation:

• Early Mobilization: Patients are encouraged to start moving their knee as soon as possible to avoid stiffness.
• Physiotherapy: An individually tailored physiotherapy program helps to restore muscle strength and knee mobility.
• Pain management: Pain medications and anti-inflammatory agents are prescribed to alleviate postoperative pain.
• Regular follow-up examinations: Regular follow-up examinations with the doctor are important to monitor the healing process and detect complications early.

Long-term results and prospects for success

The long-term results of retropatellar replacement are generally positive:

• Lifespan of the prosthesis: Modern prosthetic materials have high durability, and most prostheses last 15-20 years or longer.
• Improved quality of life: Most patients report a significant improvement in quality of life and ability to perform daily activities without pain.
• Success rate: Studies show that over 90% of patients experience significant pain relief and functional improvement after Retropatellar Resurfacing.

Alternatives to Retropatellar Resurfacing

There are also alternatives to Retropatellar Resurfacing that can be considered:

• Conservative treatment: Physical therapy, pain medication, and injections can be effective in the early stages of patellofemoral osteoarthritis.
• Partial prostheses: In some cases, a partial prosthesis (unicompartmental knee prosthesis) can be a suitable alternative.
• Total knee replacement: In cases of advanced osteoarthritis, a total knee replacement may be necessary.

Conclusion

The retropatellar replacement is a specialized and effective treatment method for patients with patellofemoral osteoarthritis who do not respond to conservative treatments. The benefits, including significant pain relief and improved functionality, generally outweigh the potential risks. Through careful patient selection, precise surgical technique, and comprehensive rehabilitation, good long-term results can be achieved.