In a recent study British researchers explored the reasons behind the high rate of second surgeries following kneecap replacement, or patellofemoral arthroplasty (PFA). What they found was startling and is traced to the fact that patients may have received the wrong type of surgery:
“Unexplained pain is the principal indication for early revision [surgery] of the failing [patello-femoral arthroplasty]. The high proportion of revisions performed for unexplained pain raises questions about the adequacy of surgical selection for patients undergoing (knee cap replacement).”
the patient’s knee hurt and according to doctors, there was no clear reason why
Remarkably in this study, forty-six percent (46%) of the patients reported pain of unknown origin following the kneecap replacement. In other words, the patient’s knee hurt and according to doctors, there was no clear reason why.(1) As speculated above, the reason for pain following a knee cap replacement could be poor patient and surgical selection with the knee cap replacement in the first place. Another study notes:
“Identification and management of patients with isolated patellofemoral osteoarthritis are challenging. Many of these patients present at a young age and it is important to distinguish degenerative change in the patellofemoral articulation from the other various causes of anterior knee pain. Once the diagnosis of isolated patellofemoral arthrosis has been made non-operative and conservative surgical techniques should be exhausted fully before prosthetic arthroplasty is considered.”(2)
Researchers are finding that surgery is not the best answer and should only be used when all conservative treatments are exhausted.
“Chronic disabling patellofemoral pain and instability can have significant effects on patient function and lifestyle. Although the management of patellofemoral pain has improved greatly, there is still a category of patient who tends to have recalcitrant symptoms, which are difficult to manage. The patient often bounces from practitioner to practitioner, physiotherapist as well as surgeon, for some relief of symptoms. However, often the underlying source of the pain is not well understood, so treatment can aggravate the symptoms.”(3)
References and more information
Is Prolotherapy a non-surgical option? Please see patellofemoral instability knee pain
1. Baker PN, Refaie R, Gregg P, Deehan D.Revision following patello-femoral arthoplasty.Knee Surg Sports Traumatol Arthrosc. 2012 Jan 7.
2. Tarassoli P, Punwar S, Khan W, Johnstone D. Patellofemoral arthroplasty: a systematic review of the literature. Open Orthop J. 2012;6:340-7. Epub 2012 Jul 27.
3. McConnell J. Management of a difficult knee problem. Man There. 2012 Jun 27. [Epub ahead of print]
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