1
|
Sambri A, Paganelli C, Parisi SC, Filippini M, Cevolani L, Stimolo D, Bortoli M, Guarino A, Bruschi A, Fiore M, Campanacci DA, Donati DM, De Paolis M. Does Patellar Height Influence Range of Motion and Anterior Knee Pain after Distal Femur Endoprosthesis Reconstruction? J Clin Med 2024; 13:4194. [PMID: 39064234 PMCID: PMC11277792 DOI: 10.3390/jcm13144194] [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: 07/02/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Objectives: This study aims to evaluate the patellar height changes after distal femur (DF) endoprosthetic replacement (EPR) and its impact on anterior knee pain (AKP) and range of motion (ROM). Methods: A retrospective review of three institutions' databases was performed. The patellar height was determined using the modified Insall-Salvati ratio (MIS), the Blackburne-Peel (BP) and the Caton-Deschamps (CD) indexes. Data regarding AKP and ROM were collected. Results: A total of 199 patients were included. The mean age at presentation was 37.9 ± 23.1 years. The mean one-year follow-up MIS, BP and CD were 1.52 (sd: 0.41), 0.82 (sd: 0.33) and 0.93 (sd: 0.33). Patellar height decreased significantly compared to the pre-operative values according to all three scores (p < 0.001). AKP was reported by 34 (17.1%) patients at 1 year follow-up. Patients with patella baja (MIS < 1.2) or pseudo patella baja (CD < 0.6) had a higher incidence of AKP (p = 0.037 and p = 0.024, respectively). The mean flexion ROM was 91°, with a direct correlation with patellar height (MIS p = 0.020, BP p = 0.036 and CD p = 0.036). Conclusion: The restoration of the native position of the joint line in DF EPR is important to maintain optimal patellofemoral biomechanics. Despite surgeons' tendency toward a reduction in patellar height with respect to pre-operative values, an increase in patellar height might help to achieve better knee flexion and reduce AKP.
Collapse
Affiliation(s)
- Andrea Sambri
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
| | - Chiara Paganelli
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
| | - Stefania Claudia Parisi
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
| | - Matteo Filippini
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
| | - Luca Cevolani
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (L.C.); (D.M.D.)
| | - Davide Stimolo
- Orthopaedic Oncology Unit, Azienda Ospedaliera Universitaria Careggi, 50134 Firenze, Italy; (D.S.); (A.G.); (D.A.C.)
| | - Marta Bortoli
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
| | - Andrea Guarino
- Orthopaedic Oncology Unit, Azienda Ospedaliera Universitaria Careggi, 50134 Firenze, Italy; (D.S.); (A.G.); (D.A.C.)
| | - Alessandro Bruschi
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
| | - Michele Fiore
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
| | - Domenico Andrea Campanacci
- Orthopaedic Oncology Unit, Azienda Ospedaliera Universitaria Careggi, 50134 Firenze, Italy; (D.S.); (A.G.); (D.A.C.)
| | - Davide Maria Donati
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (L.C.); (D.M.D.)
| | - Massimiliano De Paolis
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
| |
Collapse
|
2
|
Noyes FR, Fleckenstein CM, Nolan J. Return to Sports in Patients Aged 50 Years or Younger After Robotic-Assisted Patellofemoral Arthroplasty: A 10-Year Experience Reporting High Clinical Benefits and High Patient Satisfaction With Return to an Active Lifestyle. Am J Sports Med 2024; 52:1514-1526. [PMID: 38656145 DOI: 10.1177/03635465241237460] [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] [Indexed: 04/26/2024]
Abstract
BACKGROUND Limited data are available on return to sports and patient psychometric ratings of success after patellofemoral arthroplasty (PFA) in younger patients with high expectations to return to an active lifestyle. PURPOSE/HYPOTHESIS The purpose of this article was to determine the role of PFA and its success in meeting patient expectations regarding the return to low-impact recreational sports and an active lifestyle in younger, active patients. It was hypothesized that PFA would allow younger patients to return to low-impact sports and an active lifestyle and achieve high patient psychometric ratings. STUDY DESIGN Case series; Level of evidence, 4. METHODS In this 10-year prospective study (2009-2018), robotic-assisted PFA was performed on 44 patients (32 women and 12 men; n = 51 consecutive knees), with a mean age of 37.2 years (range, 21-50 years). The follow-up rate was 98%, with a mean of 5.3 years (range, 2-9.3 years). Primary clinical outcomes were as follows: the validated Cincinnati Knee Rating System sports activity and symptom rating scales, patient psychometric ratings of the substantial clinical benefit (SCB), and the Patient Acceptable Symptom State (PASS). Secondary outcomes were the Cincinnati Knee Rating System occupational rating, visual analog pain scale, and the 12-Item Short Form Health Survey. Survivorship was defined by conversion to total knee replacement (TKR). RESULTS Before PFA, 78% of patients (35/45 knees) were symptomatic and unable to perform recreational sports, with only 20% of patients (9/45 knees) performing some low-impact sports. After PFA, 80% of patients (36/45 knees) were able to perform low-impact sports, and 7% (3/45 knees) performed jumping-pivoting sports (P < .001). The SCB scored by the patient showed 87% of knees as good, very good, or normal. On the PASS analysis, 89% of patients (95% CI, 76%-96%) were "pleased," and 93% (95% CI, 82%-99%) would undergo surgery again. There were clinically relevant improvements in symptoms of pain, swelling, and giving way (P = .0001). Preoperatively, 91% of knees had moderate to severe pain with activities of daily living, and only 11% of knees had pain at the follow-up. Five of the 50 knees (10%) underwent TKR conversion with one patient lost to follow-up. CONCLUSION PFA resulted in a high return of patients to low-impact sports with high SCB and PASS psychometric ratings. The robotic-assisted 3-dimensional preoperative planning allowed precise intraoperative trochlear implant alignment in knees with severe trochlear dysplasia. PFA is recommended as an alternative treatment in younger patients with end-stage symptomatic patellofemoral arthritis. REGISTRATION NCT02738476 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Frank R Noyes
- Mercy Health, Noyes Knee Institute, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, Ohio, USA
| | - Cassie M Fleckenstein
- Mercy Health, Noyes Knee Institute, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, Ohio, USA
| | - Joseph Nolan
- Department of Mathematics and Statistics, Burkardt Consulting Center, Northern Kentucky University, Highland Heights, Kentucky, USA
| |
Collapse
|
3
|
Becher C, Fanourgiakis I, Kniffler H. Revision of inlay resurfacing prosthesis with patellar realignment surgery and a new inlay prosthesis for persistent patellofemoral pain und patella subluxation. Arch Orthop Trauma Surg 2023; 143:7133-7138. [PMID: 37428272 DOI: 10.1007/s00402-023-04981-0] [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: 01/11/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023]
Abstract
We present the case of a 35-year-old patient who underwent inlay patellofemoral arthroplasty (I-PFA) followed by secondary patellar realignment surgery and inlay-to-inlay revision. Revision was performed because of ongoing pain, crepitation, and lateral subluxation of the patella. The original patella component (30-mm button) was replaced with a 35-mm dome, while the Hemi-Cap Wave® (7 × 5 mm) I-PFA was replaced with the Hemi-Cap Kahuna® (10 × 5 mm). At the 1-year follow-up, the clinical symptoms were resolved. Radiography revealed an aligned patellofemoral compartment with no signs of loosening. Inlay-to-inlay PFA revision appears to be a reasonable alternative to total knee arthroplasty and conversion to onlay-PFA (O-PFA) for symptomatic patients with primary I-PFA failure. Thorough patellofemoral evaluation and appropriate patient and implant selection are key for successful I-PFA, while additional procedures for patellar realignment may also be required for satisfactory long-term outcomes.
Collapse
Affiliation(s)
- Christoph Becher
- International Center for Orthopedics, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany.
| | - Ilias Fanourgiakis
- International Center for Orthopedics, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany
| | - Heino Kniffler
- Orthopädische Praxisklinik Kelkheim, Frankenallee 1, 65779, Kelkheim, Germany
| |
Collapse
|
4
|
Rupp MC, Khan ZA, Dasari SP, Berthold DP, Siebenlist S, Imhoff AB, Chahla J, Pogorzelski J. Establishing the Minimal Clinically Important Difference and Patient Acceptable Symptomatic State following Patellofemoral Inlay Arthroplasty for Visual Analog Scale Pain, Western Ontario and McMaster Universities Arthritis Index, and Lysholm Scores. J Arthroplasty 2023; 38:2580-2586. [PMID: 37286052 DOI: 10.1016/j.arth.2023.05.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The purposes of the study were to define the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) after patello-femoral inlay arthroplasty (PFA) and to identify factors predictive for the achievement of clinically important outcomes (CIOs). METHODS A total of 99 patients who underwent PFA between 2009 and 2019 and had a minimum of 2-year postoperative follow-up were enrolled in this retrospective monocentric study. Included patients had a mean age of 44 years (range, 21 to 79). The MCID and PASS were calculated using an anchor-based approach for the visual analog scale (VAS) pain, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Lysholm patient-reported outcome measures. Factors associated with CIO achievement were determined using multivariable logistic regression analyses. RESULTS The established MCID thresholds for clinical improvement were -2.46 for the VAS pain score, -8.5 for the WOMAC score, and + 25.4 for the Lysholm score. Postoperative scores corresponding to the PASS were <2.55 for the VAS pain score, <14.6 for the WOMAC score, and >52.5 points for the Lysholm score. Preoperative patellar instability and concomitant medial patello-femoral ligament reconstruction were independent positive predictors of reaching both MCID and PASS. Additionally, inferior baseline scores and age were predictive of achieving MCID, whereas superior baseline scores and body mass index were predictive of achieving PASS. CONCLUSION This study determined the thresholds of MCID and PASS for the VAS pain, WOMAC, and Lysholm scores following PFA implantation at 2-year follow-up. The study demonstrated a predictive role of patient age, body mass index, preoperative patient-reported outcome measure scores, preoperative patellar instability, and concomitant medial patello-femoral ligament reconstruction in the achievement of CIOs. LEVEL OF EVIDENCE Prognostic Level IV.
Collapse
Affiliation(s)
- Marco-Christopher Rupp
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Zeeshan A Khan
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Suhas P Dasari
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jonas Pogorzelski
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
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.
Collapse
Affiliation(s)
- Elizabeth C Bond
- Division of Orthopedic Surgery, Duke University, Durham, North Carolina
| | | | | | | |
Collapse
|
7
|
Tischer T, Geier A, Lutter C, Enz A, Bader R, Kebbach M. Patella height influences patellofemoral contact and kinematics following cruciate-retaining total knee replacement. J Orthop Res 2023; 41:793-802. [PMID: 35949157 DOI: 10.1002/jor.25425] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 06/02/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Abstract
The role of patella height is discussed controversially in total knee arthroplasty (TKA). Therefore, this computational study aims to systematically analyze the biomechanical effect of different patella heights on patellofemoral (PF) forces and kinematics after cruciate-retaining (CR) TKA. We implemented a CR bicondylar TKA with a dome patellar button in a validated dynamic musculoskeletal multibody model of a male human knee joint. Retropatellar dynamics (contact force [N], shear force [N], patellar shift [mm], tilt [°], and rotation [°]) were evaluated during dual-limb squat motion (flexion from 0° to 90°) with simulated active muscle forces and the effects of different patella heights (Blackburne-Peel [BP] ratio of 0.39, 0.49, 0.65, 0.85, 1.01, and 1.1 were systematically examined). As active knee flexion increased, PF contact force also increased. Patella alta (BP = 1.1) resulted in higher PF contact forces compared to normal patella height (BP = 0.65) by up to 16%. Contrarily, patella baja was associated with decreased PF forces by 7%. Compared to patella baja (BP = 0.39), patella alta (BP = 1.1) considerably increased the contact force by up to 25%. Different patellar heights mainly affected PF shear forces during early knee flexion. Concerning PF kinematics, patella alta (BP = 1.1) yielded a greater lateral tilt of more than 4° and higher patellar rotation by up to 3° during deep knee flexion, compared to normal patella height (BP = 0.65). Our computational study indicates that patella alta is associated with the highest PF contact and shear force after the implantation of a CR bicondylar TKA. This should be considered in PF disorders following TKA.
Collapse
Affiliation(s)
- Thomas Tischer
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Andreas Geier
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christoph Lutter
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Andreas Enz
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Maeruan Kebbach
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Imhoff AB, Bartsch E, Becher C, Behrens P, Bode G, Cotic M, Diermeier T, Falk H, Feucht MJ, Haupt U, Hinterwimmer S, Holz J, Hutter R, Kaiser R, Knoblauch T, Nebelung W, Niemeyer P, O’Donnel T, Pagenstert G, Patzer T, Rose T, Rupp MC, Tischer T, Venjakob AJ, Vogt S, Pogorzelski J. The lack of retropatellar resurfacing at index surgery is significantly associated with failure in patients following patellofemoral inlay arthroplasty: a multi-center study of more than 260 patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:1212-1219. [PMID: 33811265 PMCID: PMC9007771 DOI: 10.1007/s00167-021-06544-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 03/18/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of patients with a minimum 2-year follow-up following contemporary patellofemoral inlay arthroplasty (PFIA) and to identify potential risk factors for failure in a multi-center study. METHODS All patients who underwent implantation of PFIA between 09/2009 and 11/2016 at 11 specialized orthopedic referral centers were enrolled in the study and were evaluated retrospectively at a minimum 2-year follow-up. Clinical outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tegner Scale, the visual analogue scale (VAS) for pain, and subjective patient satisfaction. Pre- and perioperative risk factors were compared among failures and non-failures to determine potential risk factors. RESULTS A total of 263 patients (85% follow-up rate) could be enrolled. The mean age at the time of index surgery was 49 ± 12 years with a mean postoperative follow-up of 45 ± 18 months. The overall failure rate was 11% (28 patients), of which 18% (5 patients) were patients with patella resurfacing at index surgery and 82% (23 patients) were patients without initial patella resurfacing. At final follow-up, 93% of the patients who did not fail were satisfied with the procedure with a mean transformed WOMAC Score of 84.5 ± 14.5 points, a mean KOOS Score of 73.3 ± 17.1 points, a mean Tegner Score of 3.4 ± 1.4 points and a mean VAS pain of 2.4 ± 2.0 points. An increased BMI was significantly correlated with a worse postoperative outcome. Concomitant procedures addressing patellofemoral instability or malalignment, the lack of patellofemoral resurfacing at the index surgery and a high BMI were significantly correlated with failure in our patient cohort. CONCLUSION Patellofemoral inlay arthroplasty shows high patient satisfaction with good functional outcomes at short-term follow-up and thus can be considered a viable treatment option in young patients suffering from isolated patellofemoral arthritis. Patellar resurfacing at index surgery is recommended to decrease the risk of failure. LEVEL OF EVIDENCE Retrospective case series, Level IV.
Collapse
Affiliation(s)
- Andreas B. Imhoff
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Eva Bartsch
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Christoph Becher
- ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115 Heidelberg, Germany
| | - Peter Behrens
- Orthodok, Tonndorfer Hauptstraße 71, 22045 Hamburg, Germany
| | - Gerrit Bode
- Department of Orthopedics, University Hospital of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Matthias Cotic
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Theresa Diermeier
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Holger Falk
- Gelenkzentrum Rhein-Main, Frankfurter Straße 94, 65239 Hochheim am Main, Germany
| | - Matthias J. Feucht
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Ulrich Haupt
- Orthomotion, City Clinic Thun, Marktgasse 17, 3600 Thun, Switzerland
| | | | | | - René Hutter
- Department of Orthopedics, Kantonspital Graubünden, Loëstrasse 99, 7000 Chur, Switzerland
| | - René Kaiser
- Orthocentrum, Hansastr. 1-3, 20149 Hamburg, Germany
| | - Tobias Knoblauch
- Gelenkzentrum Leipzig, Richard-Lehmann-Str. 21, 04275 Leipzig, Germany
| | - Wolfgang Nebelung
- Department of Sport Orthopedics, St. Vinzenz Hospital, Schloßstr. 85, 40477 Düsseldorf, Germany
| | - Philipp Niemeyer
- Department of Orthopedics, University Hospital of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Turlough O’Donnel
- Center for Orthopaedics, Beacon Hospital, Sandyford, Dublin 18, Dublin, Ireland
| | - Geert Pagenstert
- Knee Institute Basel, CLARAHOF Clinic of Orthopaedic Surgery, MERIAN-ISELIN-Hospital, Swiss Olympic Medical Center, Föhrenstr. 2, 4054 Basel, Switzerland
| | - Thilo Patzer
- Orthopädie-Zentrum, Schön Klinik, Am Heerdter Krankenhaus 2, 40549 Düsseldorf, Germany
| | - Tim Rose
- Gelenkzentrum Leipzig, Richard-Lehmann-Str. 21, 04275 Leipzig, Germany
| | - Marco C. Rupp
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Thomas Tischer
- Department of Orthopedics, University Hospital of Rostock, Doberanerstr. 142, 18057 Rostock, Germany
| | - Arne J. Venjakob
- Department of Sport Orthopedics, St. Vinzenz Hospital, Schloßstr. 85, 40477 Düsseldorf, Germany
| | - Stephan Vogt
- Department of Sports Orthopedics, Hessing Stiftung, Hessingstr. 17, 86199 Augsburg, Germany
| | - Jonas Pogorzelski
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| |
Collapse
|
10
|
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: 1] [Impact Index Per Article: 0.3] [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.
Collapse
|
11
|
Benignus C, Meier MK, Hirschmann MT, Tibesku CO, Beckmann J. Patientenspezifische Instrumentierung und Teilprothesen am Knie. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00463-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
12
|
[Patellofemoral inlay implants-an innovation in patellofemoral joint arthroplasty?]. DER ORTHOPADE 2021; 50:136-142. [PMID: 33355685 DOI: 10.1007/s00132-020-04059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Isolated arthrosis of the patellofemoral joint is a rare and complex disease. After conservative therapy has been exhausted, the orthopedist has various soft-tissue and bone reconstructive procedures as well as cartilage regenerative procedures at his hands. In cases of failed or unsatisfactory therapy, patellofemoral arthroplasty continues to be controversially discussed as an alternative therapy. A closer look at these studies reveals promising results with the correct indication and patient selection. The different prosthesis designs provide good postoperative results while considering general and specific risks. The current generation of patellofemoral inlay prostheses shows high patient satisfaction with significant improvements in knee function and pain relief in mid-term outcomes. However, a relatively high revision rate must be considered.
Collapse
|
13
|
Beckmann J, Meier MK, Benignus C, Hecker A, Thienpont E. Contemporary knee arthroplasty: one fits all or time for diversity? Arch Orthop Trauma Surg 2021; 141:2185-2194. [PMID: 34269891 PMCID: PMC8595166 DOI: 10.1007/s00402-021-04042-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/01/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) has historically been the preferred solution for any type of knee osteoarthritis, independently of the number of compartments involved. In these days of patient-specific medicine, mono-compartmental disease could also be approached with a more individualized treatment, such as partial knee arthroplasty (PKA). Off-the-shelf (OTS) implants are often the compromise of averages and means of a limited series of anatomical parameters retrieved from patients and the pressure of cost control by limited inventory. Personalized medicine requires respect and interest for the individual shape and alignment of each patient. MATERIALS AND METHODS A Pubmed and Google Scholar search were performed with the following terms: "patient-specific knee" and "arthroplasty" and "custom implant" and "total knee replacement" and "partial knee replacement" and "patellofemoral knee replacement" and "bicompartmental knee replacement". The full text of 90 articles was used to write this narrative review. RESULTS Unicondylar, patellofemoral and bicompartmental knee arthroplasty are successful treatment options, which can be considered over TKA for their bone and ligament sparing character and the superior functional outcome that can be obtained with resurfacing procedures. For TKA, where compromises dominate our choices, especially in patients with individual variations of their personal anatomy outside of the standard, a customized implant could be a preferable solution. CONCLUSION TKA might not be the only solution for every patient with knee osteoarthritis, if personalized medicine wants to be offered. Patient-specific mono-compartmental resurfacing solutions, such as partial knee arthroplasty, can be part of the treatment options proposed by the expert surgeon. Customized implants and personalized alignment options have the potential to further improve clinical outcome by identifying the individual morphotype and respecting the diversity of the surgical population.
Collapse
Affiliation(s)
- Johannes Beckmann
- Department of Endoprosthetics, Sportklinik Stuttgart, Stuttgart, Germany
| | - Malin Kristin Meier
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Christian Benignus
- Department of Endoprosthetics, Sportklinik Stuttgart, Stuttgart, Germany
| | - Andreas Hecker
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | |
Collapse
|
14
|
|
15
|
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.
Collapse
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
| |
Collapse
|