The Avon prosthesis is showing good functional results at 12 years with a low incidence of problems. Continuing review of the series will establish the longevity of the prosthesis.There is no evidence to date of loosening or significant wear. It is important that cases for this procedure are chosen carefully. Patients with more established arthritis, or where there has been prolonged synovitis resulting from longstanding patellofemoral damage, may not be suitable. Areas of localised chondral damage to the femoral condyles may be accepted provided they are surrounded by normal articular cartilage and the menisci and cruciates are normal.
As confidence in the results of this procedure increases, the indications can be extended to younger patients with significant damage to the patellofemoral joint. A separate review of younger patients shows that the results are similar to those of the overall group. (Ref 1)
The development of minimally invasive techniques will require smaller instruments. A new set of reduced incision instruments in under development with the ability to insert the prosthesis more accurately in both sagittal and rotation planes. As the use of this procedure expands it will be a continuing challenge to teach the management of patellofemoral disease.
References
- Leadbetter WB. Patellofemoral arthroplasty in the treatment of patellofemoral arthritis: Rationale and outcome in younger patients. Orthop.Clin. N Am 2008; 39: 363-380.
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