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Vella-Baldacchino M, Webb J, Selvarajah B, Chatha S, Davies A, Cobb JP, Liddle AD. Should we recommend patellofemoral arthroplasties to patients? Bone Jt Open 2023; 4:948-956. [PMID: 38096897 PMCID: PMC10721344 DOI: 10.1302/2633-1462.412.bjo-2023-0100.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Aims With up to 40% of patients having patellofemoral joint osteoarthritis (PFJ OA), the two arthroplasty options are to replace solely the patellofemoral joint via patellofemoral arthroplasty (PFA), or the entire knee via total knee arthroplasty (TKA). The aim of this study was to assess postoperative success of second-generation PFAs compared to TKAs for patients treated for PFJ OA using patient-reported outcome measures (PROMs) and domains deemed important by patients following a patient and public involvement meeting. Methods MEDLINE, EMBASE via OVID, CINAHL, and EBSCO were searched from inception to January 2022. Any study addressing surgical treatment of primary patellofemoral joint OA using second generation PFA and TKA in patients aged above 18 years with follow-up data of 30 days were included. Studies relating to OA secondary to trauma were excluded. ROB-2 and ROBINS-I bias tools were used. Results A total of nine studies were included, made up of four randomized controlled trials (domain 1) and five cohort studies (domain 2). PROMs and knee function specific scores developed for reporting TKA were unable to detect any difference between PFA and TKA. There was no significant difference in complications between PFA and TKA. PFAs were found to have a better postoperative range of motion. Conclusion TKA and PFA are both viable options for patients with primary PFJ OA. Over time, we have seen an emphasis on patient satisfaction and better quality of life. Recommending sacrificing healthy medial and lateral compartments to treat patellofemoral joint arthritis should be given further thought.
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Affiliation(s)
| | | | | | | | - Andrew Davies
- Department of Bioengineering, Imperial College London, London, UK
| | - Justin P. Cobb
- MSk Lab, Imperial College London, Department of Surgery & Cancer, Sir Michael Uren Hub, London, UK
| | - Alexander D. Liddle
- MSk Lab, Imperial College London, Department of Surgery & Cancer, Sir Michael Uren Hub, London, UK
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Cardenas C, Wascher DC. Outcomes of isolated patellofemoral arthroplasty. J ISAKOS 2023:S2059-7754(23)00595-3. [PMID: 37984692 DOI: 10.1016/j.jisako.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
Osteoarthritis of the patellofemoral compartment can cause significant functional impairment. Isolated patellofemoral osteoarthritis affects greater than 10% of males and females over the age of 60. Patellofemoral arthroplasty (PFA) was developed as a joint-preserving procedure that maintains natural knee kinematics in those with isolated patellofemoral disease. First-generation implants were fraught with complications, a high rate of revision, and early conversion to total knee arthroplasty (TKA). Second-generation implants have demonstrated significant improvements in patient-reported outcome measures, complication rates and implant survivorship. Factors that can affect outcomes include surgical indications, patient selection, and PFA prosthesis design. Modern PFA for isolated patellofemoral osteoarthritis has comparable outcomes to TKA for isolated patellofemoral osteoarthritis. In this article, we discuss the use of PFA, implant design, the indications and factors affecting outcomes, and comparison to TKA.
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Affiliation(s)
- Cesar Cardenas
- Department of Orthopaedic Surgery, University of New Mexico, MSC 10 5600, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Daniel C Wascher
- Department of Orthopaedic Surgery, University of New Mexico, MSC 10 5600, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
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Batailler C, Putzeys P, Lacaze F, Vincelot-Chainard C, Fontalis A, Servien E, Lustig S. Patellofemoral Arthroplasty Is an Efficient Strategy for Isolated Patellofemoral Osteoarthritis with or without Robotic-Assisted System. J Pers Med 2023; 13:jpm13040625. [PMID: 37109011 PMCID: PMC10142406 DOI: 10.3390/jpm13040625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
There is relative paucity in the literature concerning outcomes after robotic-assisted Patellofemoral Arthroplasty (PFA). The aims were (1) to evaluate outcomes in patients undergoing PFA with inlay or onlay components, with or without robotic arm assistance and (2) to identify risk factors of poor outcomes after PFA. This retrospective study included 77 PFA for isolated patellofemoral joint osteoarthritis, assigned to three groups (18 conventional technique, 17 image-free robotic-assisted system and 42 image-based robotic-assisted system). The demographic data were comparable between the three groups. The clinical outcomes assessed were: Visual Analogue Scale, Knee Society Score, Kujala score and satisfaction rate. The radiological measures were: Caton Deschamps index, patellar tilt and frontal alignment of the trochlea. Functional outcomes, satisfaction rate and residual pain were comparable between the three groups. Patellar tilt improvement was superior when a robotic device was used (either image-based or image-free) compared to the conventional technique. There were three revisions (3.9%) at the last follow-up related to femorotibial osteoarthritis progression. Multivariate analysis found no significant risk factors for poor outcomes, with respect to the surgical technique or implant design. Functional outcomes and revisions rate after PFA were comparable between the surgical techniques and implants. Robotic-assisted systems were associated with a superior improvement of the patellar tilt compared to the conventional technique.
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Affiliation(s)
- Cécile Batailler
- Department of Orthopaedics, Croix Rousse Hospital, Claude Bernard Lyon 1 University, 69004 Lyon, France
- IFSTTAR, LBMC UMR_T9406, Claude Bernard Lyon 1 University, 69100 Lyon, France
| | - Pit Putzeys
- Department of Orthopaedics, Hôpitaux Robert Schuman, L-2540 Luxembourg, Luxembourg
| | - Franck Lacaze
- Department of Orthopaedics, ORTHOSUD, Clinique St Jean Sud de France, 34430 Saint Jean de Vedas, France
| | | | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK
| | - Elvire Servien
- Department of Orthopaedics, Croix Rousse Hospital, Claude Bernard Lyon 1 University, 69004 Lyon, France
- Interuniversity Laboratory of Biology of Mobility (LIBM-EA 7424), Claude Bernard Lyon 1 University, 69003 Lyon, France
| | - Sébastien Lustig
- Department of Orthopaedics, Croix Rousse Hospital, Claude Bernard Lyon 1 University, 69004 Lyon, France
- IFSTTAR, LBMC UMR_T9406, Claude Bernard Lyon 1 University, 69100 Lyon, France
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Kunze KN, Palhares G, Uppstrom TJ, Hinkley P, Rizy M, Gomoll AH, Stein BES, Strickland SM. Establishing minimal detectable change thresholds for the international knee documentation committee and Kujala scores at one and two years after patellofemoral joint arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07341-y. [PMID: 36951980 DOI: 10.1007/s00167-023-07341-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/05/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE To define the minimal detectable change (MDC) for the international knee documentation committee (IKDC) and Kujala scores one and two years after patellofemoral joint arthroplasty (PFA). METHODS A distribution-based method (one-half the standard deviation of the mean difference between postoperative and preoperative outcome scores) was applied to establish MDC thresholds among 225 patients undergoing primary PFA at a single high-volume musculoskeletal-care center. Stability of change in MDC achievement was explored by quantifying the proportion of achievement at one- and two-year postoperative timepoints. Multivariable logistic regression analysis was performed to explore the association between sociodemographic and operative features on MDC achievement. RESULTS MDC thresholds for the Kujala score were 10.3 (71.1% achievement) and 10.6 (70.4% achievement) at one- and two years, respectively. The MDC thresholds for the IKDC score were 11.2 (78.1% achievement) and 12.3 (69.0% achievement) at one- and two years, respectively. Predictors of achieving the MDC for the Kujala and IKDC scores at both time points were lower preoperative Kujala and IKDC scores, respectively. Preoperative thresholds of ≤ 24.1 and 7.6 for the Kujala and IKDC scores, respectively, were associated with a 90% MDC achievement probability. When preoperative thresholds approached 64.3 and 48.3 for the Kujala and IKDC, respectively, MDC achievement probability reduced to 50%. CONCLUSION The MDC thresholds for the Kujala and IKDC scores two years after PFA were 10.6 and 12.3, respectively. Clinically significant health status changes were maintained overall, with a slight decrease in achievement rates between one and two years. MDC achievement was associated with disability at presentation, and several probability-based preoperative thresholds were defined. These findings may assist knee surgeons with patient selection and the decision to proceed with PFA by better understanding the patient-specific propensity for MDC achievement. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Guilherme Palhares
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Tyler J Uppstrom
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Paige Hinkley
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Morgan Rizy
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Andreas H Gomoll
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Beth E Shubin Stein
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Sabrina M Strickland
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Familiari F, Madonna V, Mercurio M, Cinque ME, Gasparini G, Galasso O, Moatshe G. Outcomes and complications of inlay versus onlay patellofemoral arthroplasty: A systematic review. Knee 2023; 41:124-136. [PMID: 36680866 DOI: 10.1016/j.knee.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/01/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of this systematic review was to evaluate outcomes and complications rates between inlay and onlay patellofemoral arthroplasty (PFA). METHODS According to the PRISMA statement, 42 studies with 2552 patients were included. Data considered for quantitative analysis consisted of the Knee Society Score (KSS), the range of motion (ROM), the visual analogue score (VAS), and the Western Ontario and McMaster Universities questionnaire (WOMAC). Complications and revision surgery were considered. RESULTS Data on postoperative KSS showed no differences between the groups. The ROM was evaluated in 8 studies for 70 and 331 inlay and onlay PFA, respectively. Onlay group was favorable in terms of postoperative ROM. Postoperative VAS was available for 64 inlay and 110 onlay and no differences were found. Data on postoperative WOMAC were available for 49 inlay and 527 onlay PFA and inlay group showed better scores. A statistically significant higher rate of instability, persistent pain, malposition, stiffness, deep infection, disease progression, and wear of the patellar component were noted in the inlay group. A higher rate of lateral release was noted in the onlay group. A higher number of manipulations under anesthesia was noted in the inlay group. The revision to total knee arthroplasty was reported more frequently in the inlay group. CONCLUSION A higher rate of conversion to total knee arthroplasty and complication rates after inlay technique was found. The potential of achieving better WOMAC scores with the inlay technique should be weighed against the higher complication and revision rates compared to the onlay technique. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Filippo Familiari
- Department of Orthopedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, 88100 Catanzaro, Italy.
| | - Vincenzo Madonna
- Department of Orthopedics, Joint Prosthetic, Arthroscopic Surgery and Sports Traumatology, Humanitas Castelli, Bergamo, Italy.
| | - Michele Mercurio
- Department of Orthopedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, 88100 Catanzaro, Italy.
| | - Mark E Cinque
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Giorgio Gasparini
- Department of Orthopedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, 88100 Catanzaro, Italy.
| | - Olimpio Galasso
- Department of Orthopedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, 88100 Catanzaro, Italy.
| | - Gilbert Moatshe
- Oslo Sport Trauma Research Center, Norwegian School of Sports Science, Oslo, Norway; Orthopaedic Clinic, Oslo University Hospital Ullevål, Oslo, Norway
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Wang Y, Bian Y, Qian W. Long-Term clinical results of patellofemoral arthroplasty for isolated patellofemoral osteoarthritis. J Orthop Surg (Hong Kong) 2023; 31:10225536231162832. [PMID: 36888931 DOI: 10.1177/10225536231162832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVES The aim of this study was to explore the clinical outcomes and long-term survival of patellofemoral arthroplasty in treatment of isolated patellofemoral osteoarthritis. METHODS We retrospectively studied a total of 46 type Y-L-Q PFAs that were designed at our institution in 38 patients. Implant survivorship was analyzed with a follow-up of 18.9-29.6 years. Knee Society Score (KSS), Oxford Knee Score (OKS), and University of California Los Angeles activity scale (UCLA) were used to assess functional outcomes. RESULTS The implant survivorship was 83.6% at 15 years, 76.8% at 20 years, and 59.4% at 25 years 14 PFAs in 12 patients were revised into total knee arthroplasty at 16.0 ± 6.7 years; 13 for progression of tibiofemoral osteoarthritis and one for polyethylene wear. The mean Knee Society Score objective scores and functional scores were 73.0 ± 17.5 (range, 49-95) and 56.4 ± 28.9 (range, 5-90), respectively. The mean Oxford Knee Score was 25.8 ± 11.5 (range, 8-44). CONCLUSION Type Y-L-Q patellofemoral arthroplasty can be an effective method for treating isolated patellofemoral osteoarthritis with satisfactory survival.
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Affiliation(s)
- Yiou Wang
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, 74698Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanyan Bian
- Department of Orthopedic Surgery, 34732Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenwei Qian
- Department of Orthopedic Surgery, 34732Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Peng Y, Lin W, Zhang Y, Wang F. Patellofemoral arthroplasty in combination with high tibial osteotomy can achieve good outcome for patients with medial-patellofemoral osteoarthritis. Front Surg 2022; 9:999208. [PMID: 36317169 PMCID: PMC9616691 DOI: 10.3389/fsurg.2022.999208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background The purpose of our study is to report on the clinical outcomes of patients who undergoing patellofemoral arthroplasty (PFA) in combination with a high tibial osteotomy (HTO). Due to this procedure's conservative and kinematics-preserving characteristics, we hypothesized that PFA in combination with HTO would result in good clinical outcomes in patients with medial and patellofemoral compartment osteoarthritis (MPFOA). Methods Patients who underwent PFA in combination with HTO for MPFOA from January 2018 to April 2020 were included in the study. Clinical outcomes were analyzed by comparing the Knee Society Score, Oxford Knee Score, Range of Motion, and Forgotten Joint Score before and after the procedure. Radiological evaluations were also performed to assess the tibiofemoral osteoarthritis progression and implant loosening. For all tests, the value of p < 0.05 was considered statistically significant. Results A total of nine consecutive patients who underwent PFA in combination with HTO were included. Two were males, seven were females. The average follow-up period was 2.6 ± 0.4 years. Clinical outcomes showed a significant improvement in the Knee Society Score (clinical score: 90.3 ± 8.5 and function score: 90.8 ± 7.8), Oxford Knee Score (43.6 ± 3.6), Forgotten Joint Score (71.2 ± 10.2), and knee Range of Motion (130.4 ± 8.1°) at the final follow-up. Additionally, hip-knee-ankle angle significantly decreased from -9.3 ± 2.1° preoperatively to 2.2 ± 1.2° at the final follow-up (p < 0.05). There were no complications for any patient during the follow-up time. Conclusion This study shows that patients who underwent PFA in combination with HTO for the treatment of MPFOA achieved good clinical and radiological outcomes. This combined surgery could be an effective alternative to treat MPFOA in well-selected patients.
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Abstract
Isolated patellofemoral osteoarthritis (PFOA) is a common cause of anterior knee pain in patients over the age of 40 years. Patellofemoral arthroplasty (PFA) is an option to address PFAO when the non-operative or joint preserving management has failed.The goals of PFA are to reduce pain and increase function of the knee in a bone and ligament preserving fashion while maintaining or optimizing its kinematics. Over the last decades advances have been made in optimizing implants designs, addressing complications and improving functional and patient reported outcomes. Appropriate patient selection has proven to be imperative. Proper surgical technique and knowledge of pearls and pitfalls is essential.The indications and surgical technique for patellofemoral arthroplasty will be reviewed here.Level of evidence: Therapeutic Level V.
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Affiliation(s)
- Paul Hoogervorst
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Ave Suite R200, Minneapolis, MN, 55454, USA
| | - Elizabeth A Arendt
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Ave Suite R200, Minneapolis, MN, 55454, USA.
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Vasso M, Corona K, Capasso L, Toro G, Schiavone Panni A. Intraarticular injection of microfragmented adipose tissue plus arthroscopy in isolated primary patellofemoral osteoarthritis is clinically effective and not affected by age, BMI, or stage of osteoarthritis. J Orthop Traumatol 2022; 23:7. [PMID: 35122541 PMCID: PMC8818068 DOI: 10.1186/s10195-022-00628-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/25/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose This study aimed to report the clinical and functional results of a series of patients with isolated primary patellofemoral osteoarthritis (PFOA) treated with intraarticular injection of microfragmented autologous adipose tissue plus knee arthroscopy. The results were also analyzed in relation to the age and body mas index (BMI) of patients, and to the stage of PFOA. Methods Twenty-three patients with early-to-moderate (stage 1–3 according to the Iwano classification system) PFOA who received this treatment were retrospectively analyzed, with a mean follow-up of 22.1 ± 4.2 months. Patients were assessed using the International Knee Society (IKS) knee and function and visual analog scale (VAS) scores, and relative to their capacity for climbing stairs. Differences in improvements of IKS and VAS scores in relation to age (< 60 versus ≥ 60 years), BMI (< 30 versus ≥ 30 kg/m2), and stage of PFOA (stages 1–2 versus stage 3) were finally analyzed. Results The mean IKS knee score significantly improved from 35.6 ± 14.9 points preoperatively to 61.9 ± 17.8 points at the latest follow-up, while the mean IKS function score significantly improved from 52.0 ± 14.7 points preoperatively to 82.3 ± 19.1 points at the latest follow-up. The mean VAS score significantly decreased from 8.7 ± 2.2 preoperatively to 5.2 ± 2.5 at the latest follow-up. A significant improvement in the capacity to climb stairs was found. No significant differences in improvements of IKS knee and function and VAS scores were found in relation to age, BMI, or stage of PFOA. Conclusion Intraarticular injection of microfragmented autologous adipose tissue following arthroscopic debridement significantly improved overall clinical and functional scores in patients with early or moderate isolated primary PFOA at a mean follow-up of almost 2 years. Improvements were not significantly affected by age, BMI, or stage of PFOA. Level of evidence Level IV, retrospective case series.
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Affiliation(s)
- Michele Vasso
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - Luigi Capasso
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Giuseppe Toro
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Alfredo Schiavone Panni
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, "Luigi Vanvitelli" University of Campania, Naples, Italy
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Springer B, Boettner F. Treatment of Unicompartmental Cartilage Defects of the Knee with Unicompartmental Knee Arthroplasty, Patellofemoral Partial Knee Arthroplasty or Focal Resurfacing. Life (Basel) 2021; 11:life11050394. [PMID: 33925287 PMCID: PMC8146542 DOI: 10.3390/life11050394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/18/2022] Open
Abstract
Focal chondral defects are common lesions of the articular cartilage. They are predominantly found on the medial femoral condyle and often progress to osteoarthritis of the knee. Various conservative treatment options are available. The conservative treatment might reduce pain and delay the progress of degenerative processes. However, restoration of the articular cartilage cannot be accomplished. If the conservative treatment fails unicompartmental arthroplasty, patellofemoral joint replacement or focal resurfacing are reasonable options to postpone total knee arthroplasty. A careful patient selection before surgery is crucial for all three treatment options. The following overview reports indications and outcomes of medial partial knee replacement, patellofemoral partial knee replacement, and focal resurfacing treatment options for focal chondral defects.
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Affiliation(s)
- Bernhard Springer
- Department of Orthopedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria;
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
- Correspondence:
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11
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Feucht MJ, Lutz PM, Ketzer C, Rupp MC, Cotic M, Imhoff AB, Pogorzelski J. Preoperative patellofemoral anatomy affects failure rate after isolated patellofemoral inlay arthroplasty. Arch Orthop Trauma Surg 2020; 140:2029-2039. [PMID: 33125548 PMCID: PMC7674339 DOI: 10.1007/s00402-020-03651-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/15/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyze whether preoperative patellofemoral anatomy is associated with clinical improvement and failure rate after isolated patellofemoral arthroplasty (PFA) using a modern inlay-type trochlear implant. METHODS Prospectively collected 24 months data of patients treated with isolated inlay PFA (HemiCAP® Wave, Arthrosurface, Franklin, MA, USA) between 2009 and 2016, and available digitalized preoperative imaging (plain radiographs in three planes and MRI) were retrospectively analyzed. All patients were evaluated using the WOMAC score, Lysholm score, and VAS pain. Patients revised to TKA or not achieving the minimal clinically important difference (MCID) for the total WOMAC score or VAS pain were considered failures. Preoperative imaging was analyzed regarding the following aspects: Tibiofemoral OA, patellofemoral OA, trochlear dysplasia (Dejour classification), patellar height (Insall-Salvati index [ISI]; Patellotrochlear index [PTI]), and position of the tibial tuberosity (TT-TG and TT-PCL distance). RESULTS A total of 41 patients (61% female) with a mean age of 48 ± 13 years could be included. Fifteen patients (37%) were considered failures, with 5 patients (12%) revised to TKA and 10 patients (24%) not achieving MCID for WOMAC total or VAS pain. Failures had a significantly higher ISI, and a significantly lower PTI. Furthermore, the proportion of patients with a pathologic ISI (> 1.2), a pathologic PTI (< 0.28), and without trochlear dysplasia were significantly higher in failures. Significantly greater improvements in clinical outcome scores were observed in patients with a higher preoperative grade of patellofemoral OA, ISI ≤ 1.2, PTI ≥ 0.28, TT-PCL distance ≤ 21 mm, and a dysplastic trochlea. CONCLUSION Preoperative patellofemoral anatomy is significantly associated with clinical improvement and failure rate after isolated inlay PFA. Less improvement and a higher failure rate must be expected in patients with patella alta (ISI > 1.2 and PTI < 0.28), absence of trochlear dysplasia, and a lateralized position of the tibial tuberosity (TT-PCL distance > 21 mm). Concomitant procedures such as tibial tuberosity transfer may, therefore, be considered in such patients. LEVEL OF EVIDENCE Level III, retrospective analysis of prospectively collected data.
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Affiliation(s)
- Matthias J Feucht
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
| | - Patricia M Lutz
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Conrad Ketzer
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marco C Rupp
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Matthias Cotic
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jonas Pogorzelski
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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