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Cardenas C, Wascher DC. Outcomes of isolated patellofemoral arthroplasty. J ISAKOS 2024; 9:796-805. [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] [MESH Headings] [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, Libert T, Oussedik S, Zaffagnini S, Lustig S. Patello-femoral arthroplasty- indications and contraindications. J ISAKOS 2024; 9:822-828. [PMID: 38185247 DOI: 10.1016/j.jisako.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/22/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
Patellofemoral arthroplasty (PFA) is emerging as an attractive alternative to total knee arthroplasty (TKA) for isolated patellofemoral-osteoarthritis (PF-OA) for selected patients. The success of PFA is highly dependent on patient selection. This intervention is still burdened with a higher rate of revisions and a lower survival rate than TKA when the indications or the surgical technique are not optimal. We highlight the indications and contraindications of PFA to obtain satisfying functional outcomes and survivorship. Preoperative clinical and radiological assessment is critical to determine the presence of PFA indications, the absence of contraindications and the necessity of any associated procedures, particularly for the tibial tubercle. The typical indications are patients with isolated symptomatic PF-OA, with trochlear dysplasia, when bone-on-bone Iwano 4 osteoarthritis is observed, without significant malalignment and with the absence of risk factors for developing progressive tibiofemoral-OA. The three main causes of isolated PF-OA are primary OA, trochlear dysplasia and posttraumatic OA following patellar fracture. Trochlear dysplasia is the preferred indication for PFA. Lack of experience with arthroplasty or realignment of the extensor mechanism is a relative contraindication to performing PFA.
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Affiliation(s)
- Cécile Batailler
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Thibaut Libert
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Sam Oussedik
- University College London Hospitals NHS Foundation Trust, NW1 2PG, London, UK
| | - Stefano Zaffagnini
- IIa Clinica Ortopedicae Traumatologica, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Sébastien Lustig
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
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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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Morrison R, Mandalia V. Current outcomes of patellofemoral arthroplasty for isolated patellofemoral arthritis - A narrative review. J Orthop 2023; 46:156-160. [PMID: 37997600 PMCID: PMC10663639 DOI: 10.1016/j.jor.2023.10.036] [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: 10/01/2023] [Revised: 10/27/2023] [Accepted: 10/29/2023] [Indexed: 11/25/2023] Open
Abstract
Patellofemoral (PFJ) arthritis can be primary, or secondary to underlying trochlea dysplasia and patellofemoral malalignment. Although primary PFJ osteoarthritis affects an older patient population, just like tibiofemoral arthritis, it is common for younger patients to present with isolated PFJ arthritis secondary to an abnormal PFJ. PFJ arthroplasty (PFJA) has many benefits including being less invasive, associated with lower blood loss, is more cost-effective, and leaves the kinematics of the tibiofemoral joint undisturbed. As a result, there are arguably better functional outcomes associated with PFJA, however the historical revision rate of this procedure is high. Although registry outcome data associated with the first generation of PFJ implants shows a higher revision rate compared to TKA, the comparison of PFJ outcomes with TKA is not always age-matched and there is limited comparison on functional and patient-reported outcomes, something which is more important and relevant in a younger patient cohort. Improvements in implant design, instrumentation, surgical technique, and better patient selection has now resulted in outcomes which are comparable to that of TKA, and in some cases even better. This narrative review outlines the current outcomes of PFJA including highlighting factors which need to be considered in optimising outcomes, as well as discussing advanced techniques of robotic assisted PFJA.
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Affiliation(s)
- Rory Morrison
- Exeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Exeter, Devon, EX2 5DW, UK
| | - Vipul Mandalia
- Exeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Exeter, Devon, EX2 5DW, UK
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Ennis HE, Phillips JLH, Jennings JM, Dennis DA. Patellofemoral Arthroplasty. J Am Acad Orthop Surg 2023; 31:1009-1017. [PMID: 37364255 DOI: 10.5435/jaaos-d-23-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
Patellofemoral arthroplasty (PFA) as a treatment option for isolated patellofemoral disease continues to evolve. Enhancement in patient selection, surgical technique, implant design, and technology has led to improved short-term and midterm outcomes. Furthermore, in the setting of a younger patient with isolated patellofemoral arthritis, PFA represents an option for improved function with faster recovery times, bone preservation, maintenance of ligamentous proprioception, and the ability to delay total knee arthroplasty (TKA). The most common reason for revising PFA to a TKA is progression of tibiofemoral arthritis. In general, conversion of PFA to TKA leads to successful outcomes with minimal bone loss and the ability to use primary TKA implants and instrumentation. PFA seems to be a cost-effective alternative to TKA in appropriately selected patients with 5-, 10-PFA survivorships of 91.7% and 83.3%, respectively, and an annual revision rate of 2.18%; however, more long-term clinical studies are needed to determine how new designs and technologies affect patient outcomes and implant performance.
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Affiliation(s)
- Hayley E Ennis
- From the Colorado Joint Replacement (Ennis, Phillips, Jennings, and Dennis), Department of Mechanical and Materials Engineering, University of Denver (Jennings, and Dennis), Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO (Dennis), and Department of Biomedical Engineering, University of Tennessee, Knoxville, TN (Dennis)
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Sava MP, Neopoulos G, Leica A, Hirschmann MT. Patellofemoral arthroplasty with onlay prosthesis leads to higher rates of osteoarthritis progression than inlay design implants: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:3927-3940. [PMID: 37005940 PMCID: PMC10435614 DOI: 10.1007/s00167-023-07404-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE The aim of this study was to report the clinical and functional outcomes, complication rates, implant survivorship and the progression of tibiofemoral osteoarthritis (OA), after new inlay or onlay patellofemoral arthroplasty (PFA), for isolated patellofemoral OA. Comparison of different implant types and models, where it was possible, also represented one of the objectives. METHODS A systematic literature search following PRISMA guidelines was conducted on PubMed, Scopus, Embase and Cochrane databases, to identify possible relevant studies, published from the inception of these databases until 11.11.2022. Randomized control trials (RCTs), case series, case control studies and cohort studies, written in English or German, and published in peer-reviewed journals after 2010, were included. Not original studies, case reports, simulation studies, systematic reviews, or studies that included patients who underwent TKA or unicompartmental arthroplasty (UKA) of the medial or lateral compartment of the knee, were excluded. Additionally, only articles that assessed functional and/or clinical outcomes, patient-reported outcomes (PROMs), radiographic progression of OA, complication rates, implant survival rates, pain, as well as conversion to TKA rates in patients treated with PFA, using inlay or onlay trochlea designs, were included. For quality assessment, the Methodological Index for Non-Randomized Studies (MINORS) for non-comparative and comparative clinical intervention studies was used. RESULTS The literature search identified 404 articles. 29 of them met all the inclusion criteria following the selection process. Median MINORS for non-comparative studies value was 12.5 (range 11-14), and for comparative studies 20.1 (range 17-24). In terms of clinical and functional outcomes, no difference between onlay and inlay PFA has been described. Both designs yielded satisfactory results at short, medium and long-term follow-ups. Both designs improved pain postoperatively and no difference between them in terms of postoperative VAS has been noted, although the onlay groups presented a higher preoperative VAS. When comparing the inlay to onlay trochlea designs, the inlay group displayed a lower progression of OA rate. CONCLUSION There is no difference in functional or clinical outcomes after PFA between the new inlay and the onlay designs, with both presenting an improvement in most of the scores that were used. A higher rate of OA progression was observed in the onlay design group. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Manuel-Paul Sava
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (BruderholzLiestalLaufen), CH-4101, Bruderholz, Switzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine and Biomechanics, University of Basel, CH-4001, Basel, Switzerland
| | - Georgios Neopoulos
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (BruderholzLiestalLaufen), CH-4101, Bruderholz, Switzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine and Biomechanics, University of Basel, CH-4001, Basel, Switzerland
| | - Alexandra Leica
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (BruderholzLiestalLaufen), CH-4101, Bruderholz, Switzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine and Biomechanics, University of Basel, CH-4001, Basel, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (BruderholzLiestalLaufen), CH-4101, Bruderholz, Switzerland.
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine and Biomechanics, University of Basel, CH-4001, Basel, Switzerland.
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