Patellofemoral Joint Disease

What is Patellofemoral Joint Disease?

Your knee is divided into three major compartments: the medial compartment, inside of the knee; the lateral compartment, the outside of the knee; and the patellofemoral compartment, the front of the knee between the kneecap and femur. In osteoarthritis of the knee, the articulating cartilage in these compartments is slowly worn away.

In advanced osteoarthritis of the patellofemoral compartment, a single compartment patellofemoral arthroplasty may be performed to alleviate pain and stiffness of the affected knee. During this procedure the back of the kneecap and the groove it articulates with are replaced with metal and plastic.

How does Patellofemoral Joint Disease occur?

Osteoarthritis of the patellofemoral joint is commonly from everyday wear-and-tear activities. It can be hereditary, but most often it is the degenerative type that comes with the aging process and is most common in women.

What are the symptoms of Patellofemoral Joint Disease occur?

A knee joint affected with osteoarthritis will be painful and inflamed. Uni-compartmental arthritis will have localized pain to one area of the knee. While pain, stiffness, and trouble bending the knee are characteristic of osteoarthritis, grinding, catching and locking symptoms may also be present with patellofemoral joint disease. Weakness and buckling at the knee will occur with advanced osteoarthritis of the kneecap, making it hard to walk, climb stairs, or exercise.

How is Patellofemoral Joint Disease diagnosed?

A complete history and physical examination will be performed. There is usually swelling, redness, tenderness, decreased range of motion (ROM), crepitus (popping/crackling at the joint), and pain with weight bearing and instability of the joint. Routine x-rays of the joint will be done that will usually show joint space narrowing, changes in the bone, and bone spurs on the patellofemoral compartment while preserving the other compartments.

How is Patellofemoral Joint Disease treated?

Nonsurgical treatment of patellofemoral joint disease includes lifestyle changes. Minimizing activities that aggravate the condition such as switching from high impact exercise to lower impact exercises such as riding a bike or swimming can be helpful in early and late stages of osteoarthritis. Losing weight is an important factor in avoiding surgery.

Exercises either done at home or with physical therapy and special braces can be recommended based on your needs. Different modalities to reduce pain and inflammation such as ice and heat application, pain relieving ointments, and medications including over the counter pain relievers, non-steroidal medications, and the COX-2 inhibitors Celebrex (celecoxib) or Mobic (meloxicam) can be tried. There are numerous injections that we provide for pain and inflammation relief such as corticosteroid injections (Zilretta) or viscosupplementation (Gel-One).

As the pain advances, surgical intervention is your option to get back to doing the things you love. PFJ disease requires a patellofemoral arthroplasty (replacement). The only compartment that is replaced with metal and/or plastic is the articulating surfaces between your kneecap and your femur. This preserves the healthy cartilage that is present in your medial and lateral compartments of the affected knee.

What is the recovery time for Patellofemoral Joint Disease treatment?

Your patellofemoral joint replacement can be done in the outpatient surgical center, and you can go home the same day. You will have a bulky dressing on your knee that can be removed and changed in 2 days. You may need to use crutches or a walker for a few days to gain mobility in the knee operated on, but you can bear weight immediately. A few hours after surgery you will be up and walking and you will start range of motion (ROM) exercises. Physical therapy is an option, but many of our patients have the understanding and motivation to gain mobility at home. You will be given home exercises to do on your own at home three times daily.  You will be followed in the office in 2 weeks post op to continue with advancement in your activities and therapy exercises. We will evaluate you at your 2-week post op appointment and may recommend physical therapy at that time, however, many of our patients are able to do the exercises on their own.  One of the best exercises for knee pain is riding the recumbent stationary bike every other day.  If you follow our instructions you should be at full recovery in 6-8 weeks.

We are here to help. If you believe you are suffering from Patellofemoral Joint Disease, we would love to deliver a diagnosis, get you treated and get you moving again.

Case of the Week - Unicondylar Knee ReplacementDr. Bramlett explains the details of a Partial Knee Replacement

This procedure involves replacing a single compartment of the knee with a custom cobalt chrome implant. This allows for an easier recovery and simpler surgery by comparison to a full knee replacement.