Hardest Patellofemoral Replacement Patients

In this video, Dr. Grant H. Garcia details the challenges and surgical strategies involved in treating the most difficult patellofemoral replacement patients—specifically those dealing with active or historical knee dislocations.

Here is a summary of his key points:

• The Hardest Patient Cases: Patients who actively dislocate or have a history of frequent dislocations present the greatest challenge. When performing a replacement for these individuals, surgeons must resurface both the trochlea (the groove) and the patella (kneecap) to establish proper stability.
• Implant Versatility: Dr. Garcia highlights his preference for the Arthrex implant system. He emphasizes that its versatility allows him to adjust the groove setting and alter the rotation directly through the implant itself, minimizing the need to constantly rely on fully customized hardware.
• Supplemental Procedures for Stability:
  • MPFL Reconstruction: For extra stabilization, he frequently adds an MPFL (medial patellofemoral ligament) reconstruction. He notes that roughly 10% to 20% (1 or 2 out of 10) of his patellofemoral replacements require this combined approach to secure patients who have tracking issues like a high TT-TG distance or patella alta (a high-riding kneecap).
  • Tibial Tubercle Osteotomy (TTO): In exceptionally severe dislocation cases, a TTO may be necessary to physically shift the bone and realign the knee. However, he stresses that this is rare, happening in only about 5% to 10% (1 in 10 to 1 in 20) of his patients.

Ultimately, he addresses a common misconception in the field, explaining that a well-designed standard implant can successfully resolve tracking and stability issues on its own without needing an overload of extra surgical procedures.