Patellofemoral arthroplasty for symptomatic nonunion after trochlear osteotomy for patellar instability: a case report

Introduction: Patients with patellofemoral instability with trochlear dysplasia may be treated with trochlear osteotomy. Case presentation: We present a patient with patellofemoral instability treated with trochlear osteotomy. The procedure resulted in nonunion with painful bony impingement and isolated patellofemoral osteoarthritis. Patellofemoral arthroplasty was performed. Conclusion: Patellofemoral arthroplasty may be considered a salvage procedure for failed surgical treatment for trochlear dysplasia. Introduction Patients with patellofemoral instability with trochlear dysplasia may be treated with trochlear osteotomy. We report a case of a patient with symptomatic bony patellofemoral impingement after a failed trochlear osteotomy. She was subsequently treated with patellofemoral arthroplasty. Case presentation A 33-year-old Dutch Caucasian woman was referred to our clinic with signs of painful bony impingement of the left patellofemoral joint. One year before presentation, she underwent a trochlear osteotomy of the left knee for recurrent patellofemoral instability with signs of trochlear dysplasia (Figure 1). There was no patella alta. Conservative treatment with physical therapy, activity modification, and taping had failed to relieve the patellofemoral instability. There was no history of any previous surgical procedures or trauma. In reviewing the operative records no complications during or directly after trochlear osteotomy were noted. Trochlear osteotomy was performed through a lateral parapatellar approach with the knee in full extension, allowing the patella to be retracted medially. After incomplete subchondral osteotomy of the anterior aspect of the lateral condyle with curved osteotomes, the articular cartilage of the anterior aspect of the lateral condyle was elevated in one piece to a height of 8 mm. Height was maintained by inserting a wedge shaped bone graft from the iliac crest and osteosynthesis with 2 screws. Patellofemoral stability was assessed through a full range of motion, and considered adequate. The synovial lining and lateral retinaculum were closed. No additional medial soft tissue surgery was performed. Direct postoperative partial weight bearing was advised with crutches, after 6 weeks full weight bearing was allowed. Published: 25 November 2009 Cases Journal 2009, 2:9086 doi:10.1186/1757-1626-2-9086 Received: 4 November 2009 Accepted: 25 November 2009 This article is available from: http://www.casesjournal.com/content/2/1/9086 © 2009 van Jonbergen and van Egmond; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.