Patellofemoral Replacement With Tibial Tubercle Osteotomy

Patellofemoral arthritis that is due to patellofemoral instability or chronic patellofemoral maltracking can be a difficult treatment problem. Isolated patellofemoral arthroplasty (PFA) is a good option that preserves bone and can more accurately reproduce native kinematics when compared with total knee arthroplasty. Newer PFA designs have demonstrated improved survivorship, although survivorship has not shown equivalence with total knee replacement. It has been postulated that improving patellar tracking could potentially improve overall outcomes and survivorship for PFA. It follows then that optimizing patellar tracking in patients with patellofemoral malalignment by adding a tibial tubercle osteotomy to a PFA may improve the ultimate outcome of the procedure. The objective of this technical note is to describe our preferred method for the treatment of patients with chronic patellofemoral lateral tracking and end-stage arthritis.