Patellofemoral Arthroplasty: Current Concepts and Review of the Literature

 

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Abstract

Patellofemoral osteoarthritis (PFOA) can be associated with anterior knee pain, stiffness, and functional impairment. Some authors report that PFOA affects approximately 9% of patients older than 40 years with a greater prevalence in females. Etiology of PFOA is multifactorial and is related to the presence of abnormal stresses at the PF joint due to knee- and patient-related factors. The need for a joint preserving treatment by isolated replacement of the injured compartment of the knee led to the development of PF arthroplasty (PFA). When a correct PF replacement is performed, PFA preserves physiologic tibiofemoral joint, thus allowing patients for a rapid recovery with a high satisfaction. The outcomes for PFA are quite variable with a trend toward good to excellent results, mainly owing to the improvement in surgical techniques, patient selection, and implant design. The development of the second generation of PFA improved the outcomes, which is attributed to the different trochlear designs. Recently, encouraging results have been provided by the association of PFA and unicompartmental knee arthroplasty (UKA). In many studies, the main cause of PFA failure is progression of tibiofemoral OA. The aim of this brief review of literature is to summarize the clinical features, indications and contraindications, surgical techniques, complications, and outcomes of PFA.

• References

• 1 Duncan R, Peat G, Thomas E, Wood L, Hay E, Croft P. Does isolated patellofemoral osteoarthritis matter?. Osteoarthritis Cartilage 2009; 17 (09) 1151-1155
  CrossrefPubMedGoogle Scholar
• 2 Lüring C, Tingart M, Drescher W, Springorum HR, Kraft CN, Rath B. Therapy of isolated arthritis in the patellofemoral joint: are there evidence-based options? [Article in German]. Orthopade 2011; 40 (10) 902-906
  CrossrefPubMedGoogle Scholar
• 3 McAlindon TE, Snow S, Cooper C, Dieppe PA. Radiographic patterns of osteoarthritis of the knee joint in the community: the importance of the patellofemoral joint. Ann Rheum Dis 1992; 51 (07) 844-849
  CrossrefPubMedGoogle Scholar
• 4 Walker T, Perkinson B, Mihalko WM. Patellofemoral arthroplasty: the other unicompartmental knee replacement. J Bone Joint Surg Am 2012; 94 (18) 1712-1720
  CrossrefPubMedGoogle Scholar
• 5 Lonner JH. Patellofemoral arthroplasty. J Am Acad Orthop Surg 2007; 15 (08) 495-506
  CrossrefPubMedGoogle Scholar
• 6 Kobayashi S, Pappas E, Fransen M, Refshauge K, Simic M. The prevalence of patellofemoral osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2016; 24 (10) 1697-1707
  CrossrefPubMedGoogle Scholar
• 7 Mills K, Hunter DJ. Patellofemoral joint osteoarthritis: an individualised pathomechanical approach to management. Best Pract Res Clin Rheumatol 2014; 28 (01) 73-91
  CrossrefPubMedGoogle Scholar
• 8 Grelsamer RP, Stein DA. Patellofemoral arthritis. J Bone Joint Surg Am 2006; 88 (08) 1849-1860
  CrossrefPubMedGoogle Scholar
• 9 Cooper C, McAlindon T, Snow S. , et al. Mechanical and constitutional risk factors for symptomatic knee osteoarthritis: differences between medial tibiofemoral and patellofemoral disease. J Rheumatol 1994; 21 (02) 307-313
  PubMedGoogle Scholar
• 10 Argenson JN, Guillaume JM, Aubaniac JM. Is there a place for patellofemoral arthroplasty?. Clin Orthop Relat Res 1995; (321) 162-167
  PubMedGoogle Scholar
• 11 Oni JK, Hochfelder J, Dayan A. Isolated patellofemoral arthroplasty. Bull Hosp Jt Dis (2013) 2014; 72 (01) 97-103
  PubMedGoogle Scholar
• 12 Culvenor AG, Cook JL, Collins NJ, Crossley KM. Is patellofemoral joint osteoarthritis an under-recognised outcome of anterior cruciate ligament reconstruction? A narrative literature review. Br J Sports Med 2013; 47 (02) 66-70
  CrossrefPubMedGoogle Scholar
• 13 Minkowitz RB, Bosco III JA. Patellofemoral arthritis. Bull NYU Hosp Jt Dis 2009; 67 (01) 30-38
  PubMedGoogle Scholar
• 14 van Jonbergen HP, Poolman RW, van Kampen A. Isolated patellofemoral osteoarthritis. Acta Orthop 2010; 81 (02) 199-205
  CrossrefPubMedGoogle Scholar
• 15 Gupta RR, Zywiel MG, Leadbetter WB, Bonutti P, Mont MA. Scientific evidence for the use of modern patellofemoral arthroplasty. Expert Rev Med Devices 2010; 7 (01) 51-66
  CrossrefPubMedGoogle Scholar
• 16 Levitt RL. A long-term evaluation of patellar prostheses. Clin Orthop Relat Res 1973; (97) 153-157
  PubMedGoogle Scholar
• 17 Blazina ME, Fox JM, Del Pizzo W, Broukhim B, Ivey FM. Patellofemoral replacement. Clin Orthop Relat Res 1979; (144) 98-102
  PubMedGoogle Scholar
• 18 Ackroyd CE, Chir B. Development and early results of a new patellofemoral arthroplasty. Clin Orthop Relat Res 2005; (436) 7-13
  PubMedGoogle Scholar
• 19 Senavongse W, Amis AA. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. J Bone Joint Surg Br 2005; 87 (04) 577-582
  CrossrefPubMedGoogle Scholar
• 20 Rauh MA, Parker RD. Patella. In: Miller MD, Thompson SR. , eds. DeLee & Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia: Saunders; 2009
  Google Scholar
• 21 Lonner JH, Bloomfield MR. The clinical outcome of patellofemoral arthroplasty. Orthop Clin North Am 2013; 44 (03) 271-280 , vii
  CrossrefPubMedGoogle Scholar
• 22 Iwano T, Kurasawa H, Tokuyama H, Hoshikawa Y. Roentgenographic and clinical findings of patellofemoral osteoarthrosis. With special reference to its relationship to femorotibial osteoarthrosis and etiologic factors. Clin Orthop Relat Res 1990; (252) 190-197
  PubMedGoogle Scholar
• 23 Sabatini L, Schirò M, Atzori F, Ferrero G, Massè A. Patellofemoral Joint Arthroplasty: our experience in isolated patellofemoral and bicompartmental arthritic knees. Clin Med Insights Arthritis Musculoskelet Disord 2016; 9: 189-193
  PubMedGoogle Scholar
• 24 Arciero RA, Toomey HE. Patellofemoral arthroplasty. A three- to nine-year follow-up study. Clin Orthop Relat Res 1988; (236) 60-71
  PubMedGoogle Scholar
• 25 Leadbetter WB, Seyler TM, Ragland PS, Mont MA. Indications, contraindications, and pitfalls of patellofemoral arthroplasty. J Bone Joint Surg Am 2006; 88 (Suppl. 04) 122-137
  PubMedGoogle Scholar
• 26 Dejour DH. The patellofemoral joint and its historical roots: the Lyon School of Knee Surgery. Knee Surg Sports Traumatol Arthrosc 2013; 21 (07) 1482-1494
  CrossrefPubMedGoogle Scholar
• 27 van Jonbergen HP, Werkman DM, Barnaart LF, van Kampen A. Long-term outcomes of patellofemoral arthroplasty. J Arthroplasty 2010; 25 (07) 1066-1071
  CrossrefPubMedGoogle Scholar
• 28 Leadbetter WB, Ragland PS, Mont MA. The appropriate use of patellofemoral arthroplasty: an analysis of reported indications, contraindications, and failures. Clin Orthop Relat Res 2005; (436) 91-99
  PubMedGoogle Scholar
• 29 Delanois RE, McGrath MS, Ulrich SD. , et al. Results of total knee replacement for isolated patellofemoral arthritis: when not to perform a patellofemoral arthroplasty. Orthop Clin North Am 2008; 39 (03) 381-388 , vii
  CrossrefPubMedGoogle Scholar
• 30 Vermeulen H, De Doncker E, Watillon M. The Mac Keever patellar prosthesis in femoro-patellar arthrosis [Article in French]. Acta Orthop Belg 1973; 39 (01) 79-90
  PubMedGoogle Scholar
• 31 Borus T, Brilhault J, Confalonieri N, Johnson D, Thienpont E. Patellofemoral joint replacement, an evolving concept. Knee 2014; 21 (Suppl. 01) S47-S50
  CrossrefPubMedGoogle Scholar
• 32 Tauro B, Ackroyd CE, Newman JH, Shah NA. The Lubinus patellofemoral arthroplasty. A five- to ten-year prospective study. J Bone Joint Surg Br 2001; 83 (05) 696-701
  CrossrefPubMedGoogle Scholar
• 33 Lustig S. Patellofemoral arthroplasty. Orthop Traumatol Surg Res 2014; 100 (1, Suppl) S35-S43
  CrossrefPubMedGoogle Scholar
• 34 Lonner JH. Patellofemoral arthroplasty: the impact of design on outcomes. Orthop Clin North Am 2008; 39 (03) 347-354 , vi
  CrossrefPubMedGoogle Scholar
• 35 Lonner JH. Patellofemoral arthroplasty: pros, cons, and design considerations. Clin Orthop Relat Res 2004; (428) 158-165
  PubMedGoogle Scholar
• 36 Cartier P, Sanouiller JL, Khefacha A. Long-term results with the first patellofemoral prosthesis. Clin Orthop Relat Res 2005; (436) 47-54
  PubMedGoogle Scholar
• 37 Odumenya M, Costa ML, Parsons N, Achten J, Dhillon M, Krikler SJ. The Avon patellofemoral joint replacement: five-year results from an independent centre. J Bone Joint Surg Br 2010; 92 (01) 56-60
  PubMedGoogle Scholar
• 38 Shakespeare D, Dikko B. A simple precise technique for making the anterior cut in patellofemoral resurfacing. Knee 2005; 12 (06) 454-455
  CrossrefPubMedGoogle Scholar
• 39 Cossey AJ, Spriggins AJ. Computer-assisted patellofemoral arthroplasty: a mechanism for optimizing rotation. J Arthroplasty 2006; 21 (03) 420-427
  CrossrefPubMedGoogle Scholar
• 40 Newman J. Isolated patellofemoral replacement. In: Romagnoli S, Confalonieri N. , eds. Small Implants in the Knee Reconstruction. Italia: Springer-Verlag; 2013
  Google Scholar
• 41 Dahm DL, Al-Rayashi W, Dajani K, Shah JP, Levy BA, Stuart MJ. Patellofemoral arthroplasty versus total knee arthroplasty in patients with isolated patellofemoral osteoarthritis. Am J Orthop 2010; 39 (10) 487-491
  PubMedGoogle Scholar
• 42 van der List JP, Chawla H, Villa JC, Pearle AD. Why do patellofemoral arthroplasties fail today? A systematic review. Knee 2017; 24 (01) 2-8
  CrossrefPubMedGoogle Scholar
• 43 Amanatullah DF, Jamali AA. Patellar polyethylene spinout after low-contact stress, high-congruity, mobile-bearing patellofemoral arthroplasty. Orthopedics 2012; 35 (02) e272-e276
  PubMedGoogle Scholar
• 44 Dy CJ, Franco N, Ma Y, Mazumdar M, McCarthy MM, Gonzalez Della Valle A. Complications after patello-femoral versus total knee replacement in the treatment of isolated patello-femoral osteoarthritis. A meta-analysis. Knee Surg Sports Traumatol Arthrosc 2012; 20 (11) 2174-2190
  PubMedGoogle Scholar
• 45 Mulford JS, Eldridge JD, Porteous AJ, Ackroyd CE, Newman JH. Revision of isolated patellofemoral arthroplasty to total knee replacement. Curr Orthop Pract 2009; 20 (04) 437-441
  CrossrefPubMedGoogle Scholar
• 46 Krajca-Radcliffe JB, Coker TP. Patellofemoral arthroplasty. A 2- to 18-year followup study. Clin Orthop Relat Res 1996; (330) 143-151
  PubMedGoogle Scholar
• 47 Kooijman HJ, Driessen AP, van Horn JR. Long-term results of patellofemoral arthroplasty. A report of 56 arthroplasties with 17 years of follow-up. J Bone Joint Surg Br 2003; 85 (06) 836-840
  PubMedGoogle Scholar
• 48 van Wagenberg JM, Speigner B, Gosens T, de Waal Malefijt J. Midterm clinical results of the Autocentric II patellofemoral prosthesis. Int Orthop 2009; 33 (06) 1603-1608
  CrossrefPubMedGoogle Scholar
• 49 Leadbetter WB, Kolisek FR, Levitt RL. , et al. Patellofemoral arthroplasty: a multi-centre study with minimum 2-year follow-up. Int Orthop 2009; 33 (06) 1597-1601
  CrossrefPubMedGoogle Scholar
• 50 Nicol SG, Loveridge JM, Weale AE, Ackroyd CE, Newman JH. Arthritis progression after patellofemoral joint replacement. Knee 2006; 13 (04) 290-295
  CrossrefPubMedGoogle Scholar
• 51 Lonner JH. Patellofemoral arthroplasty. Instr Course Lect 2010; 59: 67-84
  PubMedGoogle Scholar
• 52 de Winter WE, Feith R, van Loon CJ. The Richards type II patellofemoral arthroplasty: 26 cases followed for 1–20 years. Acta Orthop Scand 2001; 72 (05) 487-490
  CrossrefPubMedGoogle Scholar
• 53 Registry Australian Oarthopaedic Association National Joint Replacement. Available at: https://aoanjrr.sahmri.com . Accessed 2016
  PubMed
• 54 Ackroyd CE, Newman JH, Evans R, Eldridge JD, Joslin CC. The Avon patellofemoral arthroplasty: five-year survivorship and functional results. J Bone Joint Surg Br 2007; 89 (03) 310-315
  CrossrefPubMedGoogle Scholar
• 55 Starks I, Roberts S, White SH. The Avon patellofemoral joint replacement: independent assessment of early functional outcomes. J Bone Joint Surg Br 2009; 91 (12) 1579-1582
  PubMedGoogle Scholar
• 56 Mont MA, Johnson AJ, Naziri Q, Kolisek FR, Leadbetter WB. Patellofemoral arthroplasty: 7-year mean follow-up. J Arthroplasty 2012; 27 (03) 358-361
  CrossrefPubMedGoogle Scholar
• 57 Sisto DJ, Sarin VK. Custom patellofemoral arthroplasty of the knee. J Bone Joint Surg Am 2006; 88 (07) 1475-1480
  CrossrefPubMedGoogle Scholar
• 58 Butler JE, Shannon R. Patellofemoral arthroplasty with a custom-fit femoral prosthesis. Orthopedics 2009; 32 (02) 81
  CrossrefPubMedGoogle Scholar
• 59 Mohammed R, Jimulia T, Durve K, Bansal M, Green M, Learmonth D. Medium-term results of patellofemoral joint arthroplasty. Acta Orthop Belg 2008; 74 (04) 472-477
  PubMedGoogle Scholar
• 60 Parvizi J, Stuart MJ, Pagnano MW, Hanssen AD. Total knee arthroplasty in patients with isolated patellofemoral arthritis. Clin Orthop Relat Res 2001; (392) 147-152
  PubMedGoogle Scholar
• 61 Laskin RS, van Steijn M. Total knee replacement for patients with patellofemoral arthritis. Clin Orthop Relat Res 1999; (367) 89-95
  PubMedGoogle Scholar
• 62 Mont MA, Haas S, Mullick T, Hungerford DS. Total knee arthroplasty for patellofemoral arthritis. J Bone Joint Surg Am 2002; 84-A (11) 1977-1981
  PubMedGoogle Scholar
• 63 Lonner JH, Jasko JG, Booth Jr RE. Revision of a failed patellofemoral arthroplasty to a total knee arthroplasty. J Bone Joint Surg Am 2006; 88 (11) 2337-2342
  CrossrefPubMedGoogle Scholar
• 64 van Jonbergen HP, Werkman DM, van Kampen A. Conversion of patellofemoral arthroplasty to total knee arthroplasty: a matched case-control study of 13 patients. Acta Orthop 2009; 80 (01) 62-66
  CrossrefPubMedGoogle Scholar
• 65 Leadbetter WB. Patellofemoral arthroplasty in the treatment of patellofemoral arthritis: rationale and outcomes in younger patients. Orthop Clin North Am 2008; 39 (03) 363-380 , vii
  CrossrefPubMedGoogle Scholar
• 66 Lonner JH. Modular bicompartmental knee arthroplasty with robotic arm assistance. Am J Orthop 2009; 38 (2, Suppl) 28-31
  PubMedGoogle Scholar
• 67 Argenson JN, Parratte S, Bertani A. , et al. The new arthritic patient and arthroplasty treatment options. J Bone Joint Surg Am 2009; 91 (Suppl. 05) 43-48
  PubMedGoogle Scholar
• 68 Leffler J, Scheys L, Planté-Bordeneuve T. , et al. Joint kinematics following bi-compartmental knee replacement during daily life motor tasks. Gait Posture 2012; 36 (03) 454-460
  CrossrefPubMedGoogle Scholar
• 69 Heyse TJ, Khefacha A, Cartier P. UKA in combination with PFR at average 12-year follow-up. Arch Orthop Trauma Surg 2010; 130 (10) 1227-1230
  CrossrefPubMedGoogle Scholar
• 70 Kamath AF, Levack A, John T, Thomas BS, Lonner JH. Minimum two-year outcomes of modular bicompartmental knee arthroplasty. J Arthroplasty 2014; 29 (01) 75-79
  CrossrefPubMedGoogle Scholar
• 71 Parratte S, Ollivier M, Lunebourg A, Abdel MP, Argenson JN. Long-term results of compartmental arthroplasties of the knee: Long term results of partial knee arthroplasty. Bone Joint J 2015; 97-B (10, Suppl A) 9-15
  CrossrefPubMedGoogle Scholar
• 72 Cartier P, Sanouiller JL, Grelsamer R. Patellofemoral arthroplasty. 2-12-year follow-up study. J Arthroplasty 1990; 5 (01) 49-55
  CrossrefPubMedGoogle Scholar
• 73 Mertl P, Van FT, Bonhomme P, Vives P. Femoropatellar osteoarthritis treated by prosthesis. Retrospective study of 50 implants [Article in French]. Rev Chir Orthop Repar Appar Mot 1997; 83 (08) 712-718
  PubMedGoogle Scholar
• 74 Arnbjörnsson AH, Ryd L. The use of isolated patellar prostheses in Sweden 1977-1986. Int Orthop 1998; 22 (03) 141-144
  CrossrefPubMedGoogle Scholar
• 75 De Cloedt P, Legaye J, Lokietek W. Femoro-patellar prosthesis. A retrospective study of 45 consecutive cases with a follow-up of 3-12 years [Article in French]. Acta Orthop Belg 1999; 65 (02) 170-175
  PubMedGoogle Scholar
• 76 Smith AM, Peckett WR, Butler-Manuel PA, Venu KM, d'Arcy JC. Treatment of patello-femoral arthritis using the Lubinus patello-femoral arthroplasty: a retrospective review. Knee 2002; 9 (01) 27-30
  CrossrefPubMedGoogle Scholar
• 77 Board TN, Mahmood A, Ryan WG, Banks AJ. The Lubinus patellofemoral arthroplasty: a series of 17 cases. Arch Orthop Trauma Surg 2004; 124 (05) 285-287
  CrossrefPubMedGoogle Scholar
• 78 Merchant AC. A modular prosthesis for patellofemoral arthroplasty: design and initial results. Clin Orthop Relat Res 2005; (436) 40-46
  PubMedGoogle Scholar
• 79 Argenson JN, Flecher X, Parratte S, Aubaniac JM. Patellofemoral arthroplasty: an update. Clin Orthop Relat Res 2005; 440 (440) 50-53
  CrossrefPubMedGoogle Scholar
• 80 Jørgensen PS, Konradsen LA, Mati WB, Tørholm C. Treatment of patellofemoral arthritis with patello-femoral arthroplasties [Article in Danish]. Ugeskr Laeger 2007; 169 (23) 2201-2204
  PubMedGoogle Scholar
• 81 Gadeyne S, Besse JL, Galand-Desme S, Lerat JL, Moyen B. Results of self-centering patellofemoral prosthesis: a retrospective study of 57 implants [Article in French]. Rev Chir Orthop Repar Appar Mot 2008; 94 (03) 228-240
  PubMedGoogle Scholar
• 82 Charalambous CP, Abiddin Z, Mills SP, Rogers S, Sutton P, Parkinson R. The low contact stress patellofemoral replacement: high early failure rate. J Bone Joint Surg Br 2011; 93 (04) 484-489
  PubMedGoogle Scholar
• 83 Hoogervorst P, de Jong RJ, Hannink G, van Kampen A. A 21% conversion rate to total knee arthroplasty of a first-generation patellofemoral prosthesis at a mean follow-up of 9.7 years. Int Orthop 2015; 39 (09) 1857-1864
  CrossrefPubMedGoogle Scholar
• 84 Gao X, Xu ZJ, He RX, Yan SG, Wu LD. A preliminary report of patellofemoral arthroplasty in isolated patellofemoral arthritis. Chin Med J (Engl) 2010; 123 (21) 3020-3023
  PubMedGoogle Scholar
• 85 Sarda PK, Shetty A, Maheswaran SS. Medium term results of Avon patellofemoral joint replacement. Indian J Orthop 2011; 45 (05) 439-444
  CrossrefPubMedGoogle Scholar
• 86 Beitzel K, Schöttle PB, Cotic M, Dharmesh V, Imhoff AB. Prospective clinical and radiological two-year results after patellofemoral arthroplasty using an implant with an asymmetric trochlea design. Knee Surg Sports Traumatol Arthrosc 2013; 21 (02) 332-339
  CrossrefPubMedGoogle Scholar
• 87 Yadav B, Shaw D, Radcliffe G, Dachepalli S, Kluge W. Mobile-bearing, congruent patellofemoral prosthesis: short-term results. J Orthop Surg (Hong Kong) 2012; 20 (03) 348-352
  CrossrefPubMedGoogle Scholar
• 88 Davies AP. High early revision rate with the FPV patello-femoral unicompartmental arthroplasty. Knee 2013; 20 (06) 482-484
  CrossrefPubMedGoogle Scholar
• 89 Hofmann AA, McCandless JB, Shaeffer JF, Magee TH. Patellofemoral replacement: the third compartment. Bone Joint J 2013; 95-B (11, Suppl A) 124-128
  CrossrefPubMedGoogle Scholar
• 90 Morris MJ, Lombardi Jr AV, Berend KR, Hurst JM, Adams JB. Clinical results of patellofemoral arthroplasty. J Arthroplasty 2013; 28 (9, Suppl) 199-201
  PubMedGoogle Scholar
• 91 Williams DP, Pandit HG, Athanasou NA, Murray DW, Gibbons CL. Early revisions of the Femoro-Patella Vialla joint replacement. Bone Joint J 2013; 95-B (06) 793-797
  CrossrefPubMedGoogle Scholar
• 92 Al-Hadithy N, Patel R, Navadgi B, Deo S, Hollinghurst D, Satish V. Mid-term results of the FPV patellofemoral joint replacement. Knee 2014; 21 (01) 138-141
  CrossrefPubMedGoogle Scholar
• 93 Benazzo F, Rossi SM, Ghiara M. Partial knee arthroplasty: patellofemoral arthroplasty and combined unicompartmental and patellofemoral arthroplasty implants--general considerations and indications, technique and clinical experience. Knee 2014; 21 (Suppl. 01) S43-S46
  CrossrefPubMedGoogle Scholar
• 94 Dahm DL, Kalisvaart MM, Stuart MJ, Slettedahl SW. Patellofemoral arthroplasty: outcomes and factors associated with early progression of tibiofemoral arthritis. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2554-2559
  CrossrefPubMedGoogle Scholar
• 95 Fink B, Schwenninger C. Arthroplasty of the Femoropatellar Joint-What Data are Available? [Article in German]. Z Orthop Unfall 2014; 152 (02) 182-187
  Article in Thieme ConnectPubMedGoogle Scholar
• 96 Hernigou P, Caton J. Design, operative technique and ten-year results of the Hermes™ patellofemoral arthroplasty. Int Orthop 2014; 38 (02) 437-442
  CrossrefPubMedGoogle Scholar
• 97 Akhbari P, Malak T, Dawson-Bowling S, East D, Miles K, Butler-Manuel PA. The avon patellofemoral joint replacement: mid-term prospective results from an independent centre. Clin Orthop Surg 2015; 7 (02) 171-176
  CrossrefPubMedGoogle Scholar
• 98 Liow MH, Goh GS, Tay DK, Chia SL, Lo NN, Yeo SJ. Obesity and the absence of trochlear dysplasia increase the risk of revision in patellofemoral arthroplasty. Knee 2016; 23 (02) 331-337
  CrossrefPubMedGoogle Scholar