Case #4 - Custom Patellofemoral Replacement Case Study
James Butler, M.D.
History:
The patient is a 38-year-old homemaker whose knees had been a problem since age 19 when she began having anterior knee pain. Over the years she had various forms of conservative treatment. As of April 2000 she was unable to walk over two blocks and had given up all forms of exercise. Her weight had ballooned to 230 lbs. Things were not going well.
Pre-Operative X-rays:
Physical examination of the knees revealed severe bilateral patellofemoral crepitus over a 90° arc of motion sitting. The lateral retinaculum was extremely tight at 60° sitting (McConnell).
X-rays (figures 1-4) patellofemoral arthrosis showed significant tilt on the 40° - 45° tangential views (figure 4). Bilateral patellofemoral resurfacing procedures (figures 5-8) were performed April 13, 2000. A lateral retinacular release was performed to enhance patella tracking. A partial synovectomy was required to expose the anterior femur, which allows the custom patellofemoral implant to rest completely on bone. (Dr. Butler resommends full coverage of the patella with a resurfacing patella implant). She had postoperative rehabilitation at TIRR (Texas Institute of Rehabilitation and Research).
Post-Operative X-rays:
Follow up at 2 years revealed that:
- She reported that she was "perfect"
- She could kneel, squat and do yoga
- Her weight was coming down
- She could walk indefinitely
