Kneecap Reconstruction a Viable Option (written by Bilione Young @ OTW)
Five percent of 500,000 is 25,000. That is the number of patients who got a knee replacement last year who might have been just as well served by having a smaller, more focused surgery. That surgery would have reconstructed just their kneecap—called the paellofemoral.
Dr. Ronald Grelsamer, chief of patellofemoral reconstruction at Mount Sinai Medical Center, says, “A type of partial knee replacement, called a patellofemoral replacement, is an option for patients with kneecap arthritis. It’s a partial knee replacement that replaces only the kneecap and the underlying femoral groove, leaving all the healthy structures of the knee intact.”
The kneecap is a bone with a thick undersurface of cartilage. “The kneecap glides within a groove, and that groove also has cartilage,” says Grelsamer. “The cartilage is durable, but like the brakes in your car, it can wear down.” When the undersurface of the kneecap wears out and a condition called patellofemoral arthritis develops, patients may benefit from a patellofemoral replacement. “The classic symptom is persistent pain at the front of the knee, often experienced as a painful catching or locking sensation,” says Grelsamer.
Patellofemoral partial knee replacement is an option for patients with kneecap arthritis that hasn’t responded to other therapies. “We’re talking about a surgical procedure that is wonderful, but it’s the last stop on the railroad track, not the first. We remove the worn out cartilage from under the kneecap and replace it with a plastic button, and we replace the groove’s worn-out—cartilage with a small, thin, custom metallic piece.”
It’s a little like capping a tooth, he says. Compared to a total knee replacement, a patellofemoral replacement offers a quicker recovery and less blood loss.
“The operation takes about an hour, and people are usually in the hospital two days. Patients are usually on crutches for a week and a cane for two weeks, followed by two months of physical therapy,” says Grelsamer. “The pain relief can be spectacular.”
Patellofemoral partial knee replacement is a rare surgery in the U.S., though it is fairly popular in Europe. “This procedure has been a real research breakthrough,” says Grelsamer. “It’s appropriate for nearly all ages—in particular people who consider themselves too young, too old or too sick for a total knee replacement.”