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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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Yang Y, Chen Y, Wang Y, Wang J, Lu B, Zhu W, Yang N, Zhu J, Zhu C, Zhang X. The landscape of patellofemoral arthroplasty research: a bibliometric analysis. ARTHROPLASTY 2023; 5:65. [PMID: 38042843 PMCID: PMC10693710 DOI: 10.1186/s42836-023-00215-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/25/2023] [Indexed: 12/04/2023] Open
Abstract
PURPOSE Patellofemoral arthroplasty (PFA) was shown to be a potentially effective surgical technique for isolated patellofemoral osteoarthritis but varying reports on PFA-related implant failure and complications have rendered the procedure controversial. This study aimed to identify impactful publications, research interests/efforts, and collaborative networks in the field of PFA research. METHODS The study used the Web of Science Core Collection (WOSCC) database, Medline, Springer, BIOSIS Citation Index, and PubMed to retrieve relevant publications on PFA research published between 1950-2022. Statistical tests in R software were used for analysis while VOSviewer, Bibliometrix, and CiteSpace were employed for data visualization. RESULTS Two hundred forty-one articles were analyzed with the number of published papers increasing over time. Knee was the most frequent journal and Clinical Orthopaedics and Related Research was the most cited journal. Clinical outcomes, such as prosthesis survival, revision, and complications, were researched most frequently as demonstrated by keyword analysis. The United States was the top contributor to cooperative networks, followed by the United Kingdom while Technical University Munich formed close ties among authors. CONCLUSION Publications on PFA research have witnessed a notable surge. They primarily came from a limited number of centers and were characterized by low-level evidence. The majority of studies primarily focused on the clinical outcomes of PFA, while revision of PFA and patient satisfaction have emerged as new research areas.
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Affiliation(s)
- Yao Yang
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230061, China
| | - Yuan Chen
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230061, China
| | - Yingjie Wang
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230061, China
| | - Junjie Wang
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230061, China
| | - Baoliang Lu
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China
- Department of Orthopedics, Graduate School of Bengbu Medical College, Bengbu, 233030, China
| | - Wanbo Zhu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Ning Yang
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China
| | - Junchen Zhu
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230061, China.
| | - Chen Zhu
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China.
| | - Xianzuo Zhang
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China.
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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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Lachance AD, Steika R, Lutton J, Austin D. Conversion of Patellofemoral Arthroplasty to Robotic-Assisted Total Knee Arthroplasty. Arthroplast Today 2023; 23:101215. [PMID: 37745967 PMCID: PMC10514419 DOI: 10.1016/j.artd.2023.101215] [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] [Received: 03/24/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/26/2023] Open
Abstract
Conversion of patellofemoral arthroplasty to total knee arthroplasty (TKA) has been described as similar to primary TKA, although it may come with more challenges and worse outcomes. With the increased rate of revision following conversion TKA vs primary TKA, robotically assisted TKA provides an alternative technique to manual conversion. We present 3 cases of robot-assisted conversion of prior patellofemoral arthroplasty to TKA with good mechanical and clinical outcomes and no intraoperative complications.
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Affiliation(s)
| | - Roman Steika
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
| | - Jeffrey Lutton
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
| | - David Austin
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
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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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Bond EC, Stauffer TP, Hendren S, Amendola A. Modern Patellofemoral Arthroplasty. JBJS Rev 2023; 11:01874474-202309000-00002. [PMID: 37656827 DOI: 10.2106/jbjs.rvw.23.00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
INTRODUCTION The ideal procedure for isolated patellofemoral arthritis is a controversial topic. Patellofemoral arthroplasty (PFA) is an option that aims to restore normal kinematics to the knee while preserving bone. PFA has been shown to have benefits compared with total knee arthroplasty (TKA) in this patient population but has historically had a high failure rate. Revision rates are improving with modern implants and tight indications but still remain higher than TKA. This review summarizes current thinking around PFA using modern implants and techniques in 2023, provides an implant-specific analysis, and assesses how we can improve outcomes after PFA based on the current literature. The aim was to provide an outline of the evidence around PFA on which surgeons can make decisions to optimize patient outcome in this young and active population. METHODS Four databases (MEDLINE, Embase, Scopus, and SPORTDiscus) were searched for concepts of patellofemoral joint arthroplasty. After abstract and text review, a screening software was used to assess articles based on inclusion criteria for studies describing indications, outcomes, and techniques for isolated PFA using modern implants, with or without concomitant procedures. RESULTS A total of 191 articles were included for further examination, with 62 articles being instructional course lectures, systematic reviews, technique articles, narrative reviews, expert opinions, or meta-analyses. The remaining articles were case reports, trials, or cohort studies. Articles were used to create a thorough outline of multiple recurrent topics in the literature. CONCLUSIONS PFA is an appealing option that has the potential to provide a more natural feeling and functioning knee for those with isolated PF arthritis. The high rate of revision is a cause for concern and there are several technical details that should be stressed to optimize results. The uncertain outcome after revision to TKA also requires more investigation. In addition, the importance of strict selection criteria and firm indications cannot be stressed enough to optimize longevity and attempt to predict those who are likely to have progression of tibiofemoral osteoarthritis. The development of new third-generation implants is promising with excellent functional outcomes and a much lower rate of maltracking and implant complications compared with earlier generations. The impact of these implants and improvement in surgical techniques on the revision rate of PFA will be determined from longer-term outcomes.
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Affiliation(s)
- Elizabeth C Bond
- Division of Orthopedic Surgery, Duke University, Durham, North Carolina
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Treu EA, Frandsen JJ, Al Saidi NN, Blackburn BE, Pelt CE, Anderson LA, Gililland JM. Outcomes are Compromised When Revising Patellofemoral Arthroplasties for Patellar Component Failures. J Arthroplasty 2023; 38:S369-S375. [PMID: 36889525 DOI: 10.1016/j.arth.2023.02.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Outcomes of patellofemoral arthroplasty (PFA) to total knee arthroplasty (TKA) conversion are reported to be similar to primary cases. The purpose of this study was to determine whether the cause for conversion from PFA to TKA correlated to outcomes when compared to a matched cohort. METHODS A retrospective chart review was performed to identify aseptic PFA to TKA conversions between 2000 and 2021. A cohort of primary TKAs was matched by patient sex, body mass index, and American Society of Anesthesiology score. Clinical outcomes, including range of motion, complication rates, and patient reported outcomes measurement information systems scores, were compared. Chi-squared, Fisher's Exact, and t-tests were performed. There were 20 PFA to TKA conversions that met inclusion criteria and were matched to 60 primary cases. RESULTS There were 7 cases revised for arthritis progression, 5 for femoral component failure, 5 for patellar component failure, and 3 for patellar maltracking. PFA to TKA conversions for patellar failure (fracture, component loosening) had worse postoperative flexion (115 versus 127°, P = .023) and more complications of stiffness (40 versus 0%, P = .046) than primary TKAs. Conversions for failed patellar components had worse patient reported outcomes measurement information systems physical function (32 versus 45, P = .0046), physical health (42 versus 49, P = .0258), and pain scores (45 versus 24, P = .0465). No differences were found in rates of infection, manipulations under anesthesia, or reoperations. CONCLUSION PFA to TKA conversion outcomes were similar to primary TKA, except in patients who had failed patellar components and demonstrated worse postoperative range of motion and patient-reported outcomes. Surgeons should avoid thin patellar resections and extensive lateral releases to minimize patellar failures.
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Affiliation(s)
- Emily A Treu
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Jeffrey J Frandsen
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Neil N Al Saidi
- College of Medicine, Central Michigan University, Mount Pleasant, Michigan
| | - Brenna E Blackburn
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Christopher E Pelt
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Lucas A Anderson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
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8
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Serino J, Weintraub MT, Burnett RA, Angotti ML, Courtney PM, Della Valle CJ. Complications and costs of patellofemoral arthroplasty versus total knee arthroplasty. Knee 2023; 41:58-65. [PMID: 36638704 DOI: 10.1016/j.knee.2022.12.016] [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: 07/23/2022] [Revised: 10/16/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Patellofemoral arthroplasty (PFA) is an alternative to total knee arthroplasty (TKA) for the treatment of patellofemoral arthritis. Although PFA may preserve native kinematics and accelerate recovery, it has been associated with higher revision rates. The purpose of this study is to compare complication rates and costs between PFA and TKA. METHODS Using the PearlDiver database, 6,179 patients with isolated patellofemoral arthritis treated with PFA or TKA from 2010-2015 were retrospectively reviewed with 5-year follow up. PFA and TKA patients were matched by age, sex, and Elixhauser Comorbidity Index via a 1:1 stepwise algorithm. Five-year costs and complications were compared between matched cohorts. The lifetime costs of PFA and TKA were evaluated with Markov decision modeling. RESULTS Compared to TKA, PFA was associated with fewer Emergency Department (ED) visits (6.1% vs 3.9%, p = 0.004) but a higher 5-year revision rate (9.9% vs 4.2%, p < 0.001). After multivariate regression, PFA was independently more likely to require revision (odds ratio 2.60, 95% confidence interval 1.32-4.71, p = 0.003). PFA was associated with lower total healthcare costs at every time point between 3 months ($18,014 vs $26,473, p < 0.001) and 5 years ($20,837 vs $27,942, p < 0.001). On average, the lifetime cost of PFA per patient was $5,235 less than for TKA ($26,343 vs $31,578). CONCLUSIONS PFA is a less expensive alternative to TKA with a similar risk of medical complications but is associated with a significantly higher 5-year revision rate. Future studies should examine the reasons for PFA failure and methods to mitigate this risk.
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Affiliation(s)
- Joseph Serino
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60608, United States
| | - Matthew T Weintraub
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60608, United States
| | - Robert A Burnett
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60608, United States
| | - Morgan L Angotti
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60608, United States
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60608, United States.
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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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The compartmental approach to revision of partial knee arthroplasty results in nearer-normal gait and improved patient reported outcomes compared to total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:1143-1152. [PMID: 34415369 PMCID: PMC9957906 DOI: 10.1007/s00167-021-06691-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/30/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE This study investigated the gait and patient reported outcome measures of subjects converted from a partial knee arthroplasty to combined partial knee arthroplasty, using a compartmental approach. Healthy subjects and primary total knee arthroplasty patients were used as control groups. METHODS Twenty-three patients converted from partial to combined partial knee arthroplasty were measured on the instrumented treadmill at top walking speeds, using standard gait metrics. Data were compared to healthy controls (n = 22) and primary posterior cruciate-retaining total knee arthroplasty subjects (n = 23) where surgery were performed for one or two-compartment osteoarthritis. Groups were matched for age, sex and body mass index. At the time of gait analysis, combined partial knee arthroplasty subjects were median 17 months post-revision surgery (range 4-81 months) while the total knee arthroplasty group was median 16 months post-surgery (range 6-150 months). Oxford Knee Scores and EuroQol-5D 5L scores were recorded at the time of treadmill assessment, and results analysed by question and domain. RESULTS Subjects revised from partial to combined partial knee arthroplasty walked 16% faster than total knee arthroplasty (mean top walking speed 6.4 ± 0.8 km/h, vs. 5.5 ± 0.7 km/h p = 0.003), demonstrating nearer-normal weight-acceptance rate (p < 0.001), maximum weight-acceptance force (p < 0.006), mid-stance force (p < 0.03), contact time (p < 0.02), double support time (p < 0.009), step length (p = 0.003) and stride length (p = 0.051) compared to primary total knee arthroplasty. Combined partial knee arthroplasty subjects had a median Oxford Knee Score of 43 (interquartile range 39-47) vs. 38 (interquartile range 32-41, p < 0.02) and reported a median EQ-5D 0.94 (interquartile range 0.87-1.0) vs. 0.84 (interquartile range 0.80-0.89, p = 0.006). CONCLUSION This study finds that a compartmental approach to native compartment degeneration following partial knee arthroplasty results in nearer-normal gait and improved patient satisfaction compared to total knee arthroplasty. LEVEL OF EVIDENCE III.
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11
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McDonald LK, Kurmis AP. Patellar button compatibility in the conversion of Patellofemoral Arthroplasty to a Total Knee Arthroplasty: A review of the contemporary literature. J Orthop Surg (Hong Kong) 2022; 30:10225536221084147. [PMID: 35282735 DOI: 10.1177/10225536221084147] [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: 11/16/2022] Open
Abstract
BACKGROUND Compared to total knee arthroplasty (TKA), patellofemoral arthroplasty (PFA) is a far less commonly performed operation. However, in carefully selected cohorts, PFA continues to be an appropriate treatment option for end-stage isolated patellofemoral joint osteoarthritis. In the later situation whereby a PFA is considered for conversion to a TKA - often due to disease progression - uncertainty remains regarding optimal management of the in situ patellar button. This review of the contemporary literature aimed to provide a summary of the current evidence to support surgeon decision-making, by evaluating the compatibility, efficacy, and survivorship of retained versus revised patellar buttons in PFA-to-TKA conversion. Specific focus was paid to implant design and technical considerations during revision, plus post-operative patient-reported outcomes and modes of secondary patellar component failure. METHODS A review of the Embase, Cochrane and PubMed databases was performed following PRISMA search principles. RESULTS This investigation highlights that the fate of patellar buttons in PFA-to-TKA conversion has previously been poorly studied, with scant publication data available. Most reports have been of singular cases or small cohort series. Larger formal RCTs and level 1 evidence are lacking. CONCLUSION The findings herein suggest that surgeons can confidently retain well-fixed, undamaged, dome-shaped all-polyethylene patellar buttons in the conversion of a PFA to TKA with the expectation of acceptable mid-term performance and survivorship, as long as congruent tracking with the new tibiofemoral components is achieved. This result is likely translatable to the majority of contemporary, all-polyethylene, dome-shaped patellar buttons, even with manufacturer mismatch.
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Affiliation(s)
| | - Andrew P Kurmis
- College of Medicine & Public Health, 1065Flinders University, Bedford Park, SA, Australia.,Discipline of Medical Specialties, University of Adelaide, Adelaide, SA, Australia
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Benignus C, Meier M, Best R, Beckmann J. [When nothing else works: patellofemoral joint arthroplasty]. SPORTVERLETZUNG-SPORTSCHADEN 2021; 35:227-233. [PMID: 34883522 DOI: 10.1055/a-1523-9937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patellofemoral joint replacement is the best treatment option available for isolated patellofemoral arthritis. Especially young patients should be operated on with bone-sparing techniques that also preserve the soft tissues, since these patients are very likely to be revised at some point in their lifetime. Correct patient selection is important for the success of surgery and should include a meticulous clinical examination and imaging. Special attention should be paid to additional pathologies that may also need to be addressed. For the trochlea, there are two different options for treatment with the inlay and onlay system. The retropatellar surface should be replaced. Patellofemoral joint replacement is still rarely performed, so treatment in specialised centres is recommended. National joint registry data show high revision rates, while data from centres show promising results.
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Sawamura C. CORR Insights®: Molded, Gamma-radiated, Argon-processed Polyethylene Components of Rotating Hinge Knee Megaprostheses Have Lower Failure Hazard Revision Rates Than Air-sterilized, Machined, Ram-extruded Bar Stock Components. Clin Orthop Relat Res 2021; 479:102-104. [PMID: 33105303 PMCID: PMC7899559 DOI: 10.1097/corr.0000000000001534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/23/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Chigusa Sawamura
- C. Sawamura, Department of Orthopaedic Surgery, Saitama Cancer Center, Saitama, Japan
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15
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Short-term Revision Risk of Patellofemoral Arthroplasty Is High: An Analysis from Eight Large Arthroplasty Registries. Clin Orthop Relat Res 2020; 478:1222-1231. [PMID: 32348089 PMCID: PMC7319370 DOI: 10.1097/corr.0000000000001268] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral arthroplasty (PFA) is one option for the treatment of isolated patellofemoral osteoarthritis, but there are limited data regarding the procedure and results. Because isolated patellofemoral arthritis is relatively uncommon, available case series generally are small, and even within national registries, sample sizes are limited. Combining data from multiple registries may aid in assessing worldwide PFA usage and survivorship. QUESTIONS/PURPOSES We combined and compared data from multiple large arthroplasty registries worldwide to ask: (1) What proportion of patients undergoing primary knee arthroplasty have PFA? (2) What are the patient and prosthesis characteristics associated with PFA in common practice, as reflected in registries? (3) What is the survivorship free from revision of PFA and what are the reasons for and types of revisions? METHODS Data were provided by eight registries that are members of the International Society of Arthroplasty Registries (ISAR) who agreed to share aggregate data: Australia, New Zealand, Canada, Sweden, Finland, Norway, the Netherlands, and the United States. De-identified data were obtained for PFA performed from either the beginning of year 2000, or the earliest recorded implantation date after that in each individual registry when PFA data collection commenced, up to December 31, 2016. This included patient demographics, implant use, all-cause revision rate (determined by cumulative percent revision [CPR]), and reasons for and type of revision. RESULTS During the data collection period, 6784 PFAs were performed in the eight countries. PFAs comprised less than 1% of primary knee replacements in all registries. Patient demographics were comparable in all countries. Patients were generally more likely to be women than men, and the mean age ranged from 50 years to 60 years. All registries showed a high rate of revision for PFA. The 5-year CPR for any reason ranged from 8.0% (95% CI 4.5 to 11.5) in Norway to 18.1% (95% CI 15.5 to 20.7) in the Netherlands. The most common reason for revision across all countries was disease progression (42%, 434 of 1034). Most PFAs (83%, 810 of 980) were revised to a TKA. CONCLUSIONS The revision risk of PFA in all registries surveyed was more than three times higher than the reported revision risk of TKA at the same times. The survivorship of PFA is similar to that of the no-longer-used procedure of metal-on-metal conventional hip replacement. Although there may be potential functional benefits from PFA, these findings of consistent and alarmingly high rates of revision should create concern, particularly as this procedure is often used in younger patients. LEVEL OF EVIDENCE Level III, therapeutic study.
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Bendixen NB, Eskelund PW, Odgaard A. Failure modes of patellofemoral arthroplasty-registries vs. clinical studies: a systematic review. Acta Orthop 2019; 90:473-478. [PMID: 31259645 PMCID: PMC6746256 DOI: 10.1080/17453674.2019.1634865] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Patellofemoral arthroplasty (PFA) has been debated since early studies showed poor implant survival. Recent studies show better results. This review reports failure modes for PFA and investigates differences in data reported from registries and clinical studies. Additionally, we report differences in failure modes among implant designs. Methods - A systematic search was performed in September 2018. All studies and registers describing failure modes of PFA were included and implant design was noted for each revision. Results - This review includes 1,299 revisions of a primary PFA reported in 47 clinical studies and 3 registers. The failure modes were: 42% OA progression, 16% pain, 13% aseptic loosening, 12% surgical error, 4% wear, 2% infection, 2% broken patellar component, 1% stiffness, 1% fracture, and 7% other. The data from registries and cohort studies differed statistically significantly in 7 out of 12 failure modes. Significant differences were found in several failure modes among implant designs. Interpretation - OA progression is the most common failure mode of PFA. There are significant differences in data on failure modes between registers and protocolled studies, notably for surgical error. The implant design significantly influences several of the failure modes. In conclusion, indication, surgical technique, and implant design are important for a successful PFA, and register-based failure modes should be interpreted with caution.
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Affiliation(s)
- Nikolaj B Bendixen
- Department of Orthopedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark,Correspondence:
| | - Peter W Eskelund
- Department of Orthopedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Anders Odgaard
- Department of Orthopedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
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CORR Insights®: What Is the Risk of Repeat Revision When Patellofemoral Replacement Is Revised to TKA? An Analysis of 482 Cases From a Large National Arthroplasty Registry. Clin Orthop Relat Res 2019; 477:1411-1413. [PMID: 31136443 PMCID: PMC6554105 DOI: 10.1097/corr.0000000000000583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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