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The Journal of Bone and Joint Surgery (American) 84:1132-1137 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Patellar Impingement Following Unicompartmental Arthroplasty

P. Hernigou, MD and G. Deschamps, MD

Investigation performed at the Henri Mondor Hospital, Creteil, France

P. Hernigou, MD
Université Paris XII, Hôpital Henri Mondor, 94010 Creteil, France. E-mail address: philippe.hernigou{at}hmr.ap-hop-paris.fr

G. Deschamps, MD
Clinique de Dracy, 71640 Dracy le Fort, France

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Patellofemoral complications (osteoarthritis and impingement) have been rarely reported after unicompartmental arthroplasty, and their long-term consequences are not known. The purpose of the present study was to analyze these complications following unicondylar arthroplasty.

Methods: We evaluated the results of ninety-nine unicompartmental arthroplasties that had been performed in eighty patients with osteoarthritis of the knee. The medial compartment was replaced in seventy-four knees and the lateral compartment, in twenty-five. All ninety-nine knees were evaluated with regard to patellar impingement and osteoarthritic changes on skyline radiographs after an average duration of follow-up of fourteen years (range, ten to twenty years). In addition, the seventy-seven knees (fifty-eight patients) that had not been revised were evaluated with use of the clinical scoring system of the Knee Society and specific questions regarding patellofemoral symptoms after an average duration of follow-up of fifteen years (range, ten to twenty years). The relationship between patellar complications (osteoarthritis and impingement) and the position of the femoral component was evaluated with use of lateral radiographs of the knee.

Results: At the time of the most recent follow-up, twenty-nine knees had osteoarthritic changes in the portion of the patellofemoral joint opposite the compartment with the implant and twenty-eight knees had impingement of the femoral component on the patella. The knees that had impingement did not have osteoarthritic changes. Pain while ascending or descending stairs and pain on rising from a chair were noted more frequently in knees with patellar complications (impingement and osteoarthritis) (p = 0.02), and these symptoms affected the stair-climbing functional score. These symptoms were more severe in knees with patellar impingement than in knees with degenerative changes. One revision was performed because of patellar impingement. Patellar impingement was more frequent after lateral arthroplasty than after medial arthroplasty (p = 0.02) and was associated with placement of the femoral component too far anteriorly (p = 0.001).

Conclusion: After unicompartmental arthroplasty, the patellofemoral joint was affected by degenerative changes and patellar impingement. These complications appeared to have been mutually exclusive and affected the functional outcome of the arthroplasty. Patellar impingement affected the knee more severely with regard to both symptoms and the need for revision.


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