Background: Multiple treatment methods have been advocated for patellofemoral arthritis. The purpose of the present study was to report on our experience with the use of total joint replacement for the treatment of primarily severe patellofemoral arthritis of the knee in patients more than fifty-five years of age.

Methods: Between January 1980 and December 1994, thirty knee replacements were performed in twenty-seven patients for the treatment of arthritis that primarily involved the patellofemoral joint. The Ahlbäck radiographic evaluation scale was used to grade the severity of arthritis; the mean score was 4.83 points (range, 4 to 5 points) for the patellofemoral compartment and 0.6 point (range, 0 to 1 point) for both the medial and lateral compartments. The patients included eighteen women and nine men who had a mean age of seventy-three years (range, fifty-nine to eighty-eight years). None of the patients had had any prior procedures on the knee, but all had been treated for a minimum of six months with nonoperative measures. The mean preoperative Knee Society score was 50 points (range, 20 to 64 points).

Results: At a mean duration of follow-up of eighty-one months (range, forty-eight to 133 months), there were twenty-eight excellent, one good, and one poor result. The mean Knee Society objective score was 93 points (range, 67 to 100 points). The poor result was in a patient who sustained a rupture of the patellar tendon postoperatively as the result of a fall, which necessitated a tendon reconstruction.

Conclusion: Total knee arthroplasty was found to be a viable treatment option in patients more than fifty-five years of age with primarily severe patellofemoral disease.