Trochleoplasty – the new frontier in patella instability treatment

Patella instability once was treated with a knee splint for three weeks, then physiotherapy. That model has been long abandoned, the knee needs to be moving or the quadriceps get weak. If there’s not much swelling, straight to physio for a first dislocation. If the quadriceps have gone on strike – a knee arthroscopic washout of the haemarthrosis has some advantage allowing the physiotherapist to get to work with the patient. At the same time the situation can be properly assessed, any loose bodies removed.

For recurrent dislocations, more serious surgical options such as tibial tubercle surgery can change the vectors on the patella (TTTG, Q angle), lock it in the groove by moving it distally (for patella alta), and can even be used to reduce patellofemoral contact stress (for damaged kneecaps). These operations needs significant protection for eight weeks after surgery with braceing and crutches. Sometimes, the MPFL needs reconstructing.

To the title of the blog though – the patella groove is sometimes just wrong – or “dysplastic” where the lateral trochlear doesn’t provide enough support, the groove too shallow, or the medial trochlear is too high. We can deepen the groove for the patella. There is a now special tools to do this work, and the recovery of the cases we’ve done have been impressive. By removing bone from under the articular cartilage & subchondral bone plate, the area can be re-contoured, and re-secured. It is a big, open operation, sometimes the MPFL still needs to be reconstructed. Orthopaedic literature shows trochleoplasty is a critical part of the patella stabilisation surgery when indicated and patient satisfaction rates are high.

Luke Spencer & David Mitchell are both members of the Australian Knee Society, and do this surgery

Arthroplasty for Fractures

The role of joint replacement for fractures continues to expand.

Old hat now is hemiarthroplasty for neck of femur fractures. Initially a prosthesis designed by Austin Moore in the 1940’s was the first off the shelf body replacement part in the world. Now, the more common approach is to do a bipolar or even a total hip replacement, the arguments are about surgical approaches that modify the risk required ratio.

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3D Printing in Surgery Solution

We have extensive experience with boney deformity correction. The most common is a bow deformity just below the knee – this eventually causes pain on the inner aspect of the knee, and arthritis. If we get to it early enough, correcting the deformity fixes the pain, and either slows or stops the onset of arthritis.

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Inpatient Rehabilitation Doesn’t Help Most Joint Replacement Patients

Research from Mater Hospital Sydney. Of 748 patients having hip or knee replacement, only 44 patients chose to go directly home. They matched these patients to 44 most similar remaining in rehabilitation. Satisfaction with the surgery was HIGHER in the patients discharged directly home, and the health outcomes were not changed. They concluded that rehabilitation doesn’t help.

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Patello-femoral Replacement.

Where the knee-cap rubs against the front of the femur, a small category of patients develop arthritis, and require a knee replacement. Some of these are suitable for partial replacement of the patello-femoral joint (PFJ).

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