Patellofemoral Osteoarthritis, Should We Replace or Osteotomize?

Athletes are prone to patellofemoral arthritis, a multi-factorial condition including patellofemoral malalignment, instability, overuse, and trauma incurred across diverse sporting disciplines. Surgical options for treating this condition include extensor mechanism realignment osteotomy and patellofemoral arthroplasty. Each procedure carries distinct advantages and considerations. Selection of the most suitable approach requires a comprehensive understanding of the procedures and patient specific factors such as severity of cartilage defects, malalignment, and the patient's preferences, and activity goals. For early-stage patellofemoral osteoarthritis, particularly in cases involving malalignment, tibial tubercle osteotomy can be an effective treatment, while arthroplasty becomes more valuable in more advanced and progressive cases. This chapter aims to establish a clear algorithmic approach for the utilization of realigning tibial tubercle osteotomy and patellofemoral arthroplasty in the management of patellofemoral osteoarthritis.