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Villa JC, Paoli AR, Nelson-Williams HW, Badr RN, Harper KD. Onlay Patellofemoral Arthroplasty in Patients With Isolated Patellofemoral Arthritis: A Systematic Review. J Arthroplasty 2021; 36:2642-2649. [PMID: 33795175 DOI: 10.1016/j.arth.2021.02.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patellofemoral arthroplasty (PFA) for isolated patellofemoral osteoarthritis (OA) remains controversial due to variable postoperative outcomes and high failure rates. Second-generation (2G) onlay prostheses have been associated with improved postoperative outcomes. This systematic review was performed to assess the current overall survivorship and functional outcomes of 2G PFA. METHODS A search was performed using PubMed, Cochrane Library, EMBASE, and Google Scholar. Thirty-three studies published in the last 15 years (2005-2020) were included; of these 22 studies reported patient-reported outcome measures. Operative and nonoperative complications were analyzed. Pooled statistical analysis was performed for survivorship and functional scores using Excel 2016 and Stata 13. RESULTS The mean age of the patients was 59.7. When analyzing all studies, weighted survival at mean follow-up of 5.52 was 87.72%. Subanalysis of studies with minimum 5 years of follow up showed a survival of 94.24%. Fifteen studies reported Oxford Knee Score with a weighted mean postoperative Oxford Knee Score of 33.59. Mean American Knee Society Score pain was 79.7 while mean American Knee Society Score function was 79.3. The most common operative complication was OA progression for all implants. The percentage of revisions and conversions reported after analyzing all studies was 1.37% and 7.82% respectively. CONCLUSION Safe and acceptable results of functional outcomes and PFA survivorship can result from 2G PFAs at both short and mid-term follow-up for patients with isolated patellofemoral OA. However, long-term follow-up outcomes are still pending for the newer implants. More extensive studies using standardized functional outcomes and long-term cost benefits should be evaluated.
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Affiliation(s)
- Jordan C Villa
- Orthopaedic Surgery Department, Howard University Hospital, Washington, DC
| | - Albit R Paoli
- Orthopaedic Surgery Department, Howard University Hospital, Washington, DC
| | | | - Rhamee N Badr
- Orthopaedic Surgery Department, Howard University Hospital, Washington, DC
| | - Katharine D Harper
- Orthopaedic Surgery Department, Washington DC Veterans Affairs Medical Center, Washington, DC
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2
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Peng G, Liu M, Guan Z, Hou Y, Liu Q, Sun X, Zhu X, Feng W, Zeng J, Zhong Z, Zeng Y. Patellofemoral arthroplasty versus total knee arthroplasty for isolated patellofemoral osteoarthritis: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:264. [PMID: 33858458 PMCID: PMC8048312 DOI: 10.1186/s13018-021-02414-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/07/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Isolated patellofemoral osteoarthritis (PF-OA) is a common subtype of knee osteoarthritis, leading to a huge economic burden on health care systems. Although previous studies have shown that patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA) have good clinical effects, it remains largely unclear which treatment is more effective for patients with isolated PF-OA. We aimed to compare postoperative function, complications, revision rates, level of physical activity, and satisfaction rate between the two surgical techniques. METHODS Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Search of literature was conducted in MEDLINE, EMBASE, Cochrane Library, and Web of Science until November 2020. The included studies were those that provided direct comparison of postoperative outcomes between PFA and TKA. Data were extracted from eligible studies and combined to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). Sensitivity analysis and subgroup analysis were conducted to evaluate heterogeneity between the two groups. RESULTS A total of 7 eligible studies (3 recent randomized controlled trials and 4 nonrandomized controlled trials) were included in this meta-analysis. The pooled results showed that both the PFA group and the TKA group had improved postoperative indicators, suggesting that the two operation modes could improve the knee function and quality of life of patients. Throughout the first 2 years postoperatively, higher activity level, and better functional recovery were observed for PFA compared with TKA in this study; moreover, the differences between the two operation modes were statistically significant (p < 0.05). We found no significant difference in complications, revision rates, and satisfaction rate between the two procedures. CONCLUSION Although there was no observed difference in the complications, revision rates, and satisfaction rate between PFA and TKA, PFA was superior to TKA in terms of knee function and physical activity in the first 2 years postoperatively. Therefore, PFA is a safe, effective, and less invasive treatment for patients with isolated PF-OA. Our findings are consistent with the systematic review of current evidence that PFA may be more suitable for younger patients with high activity needs. Patient selection is, therefore, thought to be of paramount importance. Individualized surgical plan should be designed according to the patient's age, BMI, KOA site, and activity level and combined with the doctor's personal experience.
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Affiliation(s)
- Guanrong Peng
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China.,Yudu People's Hospital, Huancheng North Road 2#, District Yudu, Ganzhou, Jiangxi, China
| | - Min Liu
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Zhenhua Guan
- Yudu People's Hospital, Huancheng North Road 2#, District Yudu, Ganzhou, Jiangxi, China
| | - Yunfei Hou
- Peking University People's Hospital, Arthritis Clinic and Research Center Beijing, Beijing, China
| | - Qiang Liu
- Peking University People's Hospital, Arthritis Clinic and Research Center Beijing, Beijing, China
| | - Xiaobo Sun
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Xingyang Zhu
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Wenjun Feng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, Guangdong, China
| | - Jianchun Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, Guangdong, China
| | - Zhangrong Zhong
- Yudu People's Hospital, Huancheng North Road 2#, District Yudu, Ganzhou, Jiangxi, China.
| | - Yirong Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, Guangdong, China.
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Hassebrock JD, Makovicka JL, Wong M, Patel KA, Scott KL, Deckey DG, Chhabra A. Minimally Invasive Robotic-Assisted Patellofemoral Arthroplasty. Arthrosc Tech 2020; 9:e425-e433. [PMID: 32368460 PMCID: PMC7188930 DOI: 10.1016/j.eats.2019.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/18/2019] [Indexed: 02/03/2023] Open
Abstract
Isolated patellofemoral arthritis is a common debilitating condition in adults older than 40 years of age. Surgical options such as patellofemoral arthroplasty exist for those who failed to respond to nonoperative treatment. However, early patellofemoral arthroplasty techniques often resulted in poor outcomes due to mal-tracking and malalignment of components. Robotic-assisted surgery recently has been introduced as an alternative to classic patellofemoral arthroplasty, with the potential to improve the anatomical fit and reproducibility of implant positioning. We present the technique for minimally invasive robotic-assisted patellofemoral arthroplasty system.
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Affiliation(s)
| | | | - Michael Wong
- Department of Orthopedic Surgery, Ochsner Clinical School, New Orleans, Louisiana, U.S.A
| | - Karan A. Patel
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Kelly L. Scott
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - David G. Deckey
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona,Address correspondence to Dr. Anikar Chhabra, Department of Orthopedic Surgery, Mayo Clinic Arizona, 5777 East Mayo Blvd., Phoenix, AZ 85054.
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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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Survivorship and functional outcomes of patellofemoral arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25:2622-2631. [PMID: 26590562 DOI: 10.1007/s00167-015-3878-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/10/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Historically poor results of survivorship and functional outcomes of patellofemoral arthroplasty (PFA) have been reported in the setting of isolated patellofemoral osteoarthritis. More recently, however, fairly good results of PFA were reported, but the current status of PFA outcomes is unknown. Therefore, a systematic review was performed to assess overall PFA survivorship and functional outcomes. METHODS A search was performed using PubMed, Embase and Cochrane systems, and the registries were searched. Twenty-three cohort studies and one registry reported survivorship using Kaplan-Meier curve, while 51 cohort studies reported functional outcomes of PFA. RESULTS Twelve studies were level II studies, while 45 studies were level III or IV studies. Heterogeneity was mainly seen in type of prosthesis and year the cohort started. Nine hundred revisions in 9619 PFAs were reported yielding 5-, 10-, 15- and 20-year PFA survivorships of 91.7, 83.3, 74.9 and 66.6 %, respectively, and an annual revision rate of 2.18. Functional outcomes were reported in 2587 PFAs with an overall score of 82.2 % of the maximum score. KSS and Knee Function Score were 87.5 and 81.6 %, respectively. CONCLUSION This systematic review showed that fairly good results of PFA survivorship and functional outcomes were reported at short- and midterm follow-up in the setting of isolated patellofemoral osteoarthritis. Heterogeneity existed mainly in prosthesis design and year the cohort started. CLINICAL RELEVANCE These results provide a clear overview of the current status of PFA in the setting of isolated patellofemoral osteoarthritis. LEVEL OF EVIDENCE IV.
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6
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van der List JP, Chawla H, Villa JC, Pearle AD. Why do patellofemoral arthroplasties fail today? A systematic review. Knee 2017; 24:2-8. [PMID: 27825938 DOI: 10.1016/j.knee.2015.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/13/2015] [Accepted: 11/15/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Historically poor results of patellofemoral arthroplasty (PFA) were reported in the setting of isolated patellofemoral osteoarthritis (OA). In order to lower PFA failure rates, it is important to identify failure modes using a standardized method. In this systematic review, PFA failure modes were assessed and compared in early vs. late failures and older vs. recent studies. METHODS Databases of PubMed, Embase and Cochrane and annual registries were searched for studies reporting PFA failures. Failure modes in studies with mean follow-up <5years were classified as early failures while >5years were classified late failures. Cohorts started before 2000 were classified as older studies and started after 2000 as recent studies. RESULTS Thirty-nine cohort studies (10 level II and 29 level III or IV studies) and three registries were included with overall low quality of studies (GRADE criteria). A total of 938 PFA failures were included and were caused by OA progression (38%), pain (16%), aseptic loosening (14%) and patellar maltracking (10%). Pain was responsible for most early failures (31%), while OA progression was most common in late failures (46%). In older studies, OA progression was more commonly reported as failure mode than in more recent studies (53% vs. 39%, p=0.005). CONCLUSION This level IV systematic review with low quality of studies identified OA progression and pain as major failure modes. Reviewing these studies, appropriate patient selection could prevent PFA failures in select cases. Future studies assessing the role of PFA in isolated patellofemoral OA are necessary.
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Affiliation(s)
- J P van der List
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
| | - H Chawla
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
| | - J C Villa
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
| | - A D Pearle
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
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Vandenneucker H, Labey L, Vander Sloten J, Desloovere K, Bellemans J. Isolated patellofemoral arthroplasty reproduces natural patellofemoral joint kinematics when the patella is resurfaced. Knee Surg Sports Traumatol Arthrosc 2016; 24:3668-3677. [PMID: 25381467 DOI: 10.1007/s00167-014-3415-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 10/29/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The objectives of this in vitro project were to compare the dynamic three-dimensional patellofemoral kinematics, contact forces, contact areas and contact pressures of a contemporary patellofemoral prosthetic implant with those of the native knee and to measure the influence of patellar resurfacing and patellar thickness. The hypothesis was that these designs are capable to reproduce the natural kinematics but result in higher contact pressures. METHODS Six fresh-frozen specimens were tested on a custom-made mechanical knee rig before and after prosthetic trochlear resurfacing, without and with patellar resurfacing in three different patellar thicknesses. Full three-dimensional kinematics were analysed during three different motor tasks, using infrared motion capture cameras and retroflective markers. Patellar contact characteristics were registered using a pressure measuring device. RESULTS The patellofemoral kinematic behaviour of the patellofemoral arthroplasty was similar to that of the normal knee when the patella was resurfaced, showing only significant (p < 0.0001) changes in patellar flexion. Without patellar resurfacing, significant more patellar flexion, lateral tilt and lateral rotation was noticed. Compared to the normal knee, contact pressures were significantly elevated after isolated trochlear resurfacing. However, the values were more than doubled after patellar resurfacing. Changes in patellar thickness only influenced the antero-posterior patellar position. There was no other influence on the kinematics, and only a limited influence on the contact pressures in the low flexion angles. CONCLUSION The investigated design reproduced the normal patellofemoral kinematics acceptable well when the patella was resurfaced. From a kinematic point of view, patellar resurfacing may be advisable. However, the substantially elevated patellar contact pressures remain a point of concern in the decision whether or not to resurface the patella. This study therefore not only adds a new point in the discussion whether or not to resurface the patella, but also supports the claimed advantage that a patellofemoral arthroplasty is capable to reproduce the natural knee kinematics.
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Affiliation(s)
- Hilde Vandenneucker
- Department of Development and Regeneration - Orthopaedic Surgery, University Hospitals Leuven, Weligerveld 1, 3212, Pellenberg-Lubbeek, Belgium.
| | - Luc Labey
- European Centre for Knee Research, Smith&Nephew, Technologielaan 11 bis, 3000, Leuven, Belgium
| | - Jos Vander Sloten
- Biomechanics Section, University of Leuven, Celestijnenlaan 300c, 3000, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg-Lubbeek, Belgium
| | - Johan Bellemans
- Department of Development and Regeneration - Orthopaedic Surgery, University Hospitals Leuven, Weligerveld 1, 3212, Pellenberg-Lubbeek, Belgium
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8
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Vasta S, Papalia R, Zampogna B, Espregueira-Mendes J, Amendola A. Current design (onlay) PFA implants have similar complication and reoperation rates compared to those of TKA for isolated PF osteoarthritis: a systematic review with quantitative analysis. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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9
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A 21 % conversion rate to total knee arthroplasty of a first-generation patellofemoral prosthesis at a mean follow-up of 9.7 years. INTERNATIONAL ORTHOPAEDICS 2015; 39:1857-64. [DOI: 10.1007/s00264-015-2941-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
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10
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Vandenneucker H, Labey L, Victor J, Vander Sloten J, Desloovere K, Bellemans J. Patellofemoral arthroplasty influences tibiofemoral kinematics: the effect of patellar thickness. Knee Surg Sports Traumatol Arthrosc 2014; 22:2560-8. [PMID: 25023661 DOI: 10.1007/s00167-014-3160-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 06/28/2014] [Indexed: 01/12/2023]
Abstract
PURPOSE Although controversy still remains, isolated patellofemoral arthroplasty recently gained in popularity as a treatment option for patellofemoral osteoarthritis. It has compared to total knee arthroplasty the advantage of preserving the tibiofemoral articulation, which in theory would allow the preservation of natural tibiofemoral kinematics. Today, however, no data exist to support this assumption. This study was therefore performed in order to investigate the effect of isolated patellofemoral arthroplasty on the native three-dimensional tibiofemoral kinematic behaviour and whether a change in patellar thickness would have an influence. METHODS Six fresh-frozen cadavers were fixed on a custom-made mechanical knee rig. Full 3D kinematics was analysed during passive flexion-extension cycles, open chain extension, with and without mechanical resistance, as well as deep knee squats, using infrared motion capture cameras and retroflective markers. Measurements were taken for the native knee and after prosthetic trochlear resurfacing with and without patellar resurfacing in three different patellar thicknesses. RESULTS Compared to the natural knee, patellofemoral arthroplasty resulted in significant changes in tibiofemoral kinematics, which were most pronounced in the most loaded motor tasks. Increased internal tibial rotation was noted in the mid- and high flexion ranges, reaching at 120° of flexion a mean difference of 4.5°±4.3° (p<0.0001) during squat motion, over the whole flexion range during open chain motion and in deeper flexion beyond 50° (mean at 70°, 1.9°±3.7°) during resisted open chain. During squats, also, a more posterior translation of the lateral femoral condyle was observed. The effect was accentuated in case of patella overstuffing, whereas kinematics was closer to normal with patellar thinning. CONCLUSION Isolated patellofemoral arthroplasty alters natural tibiofemoral kinematics, and the effects become more pronounced in case of increased patellar thickness. Therefore, it might be recommended to aim for a slight over-resection of patellar bone if sufficient bone stock is available.
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Affiliation(s)
- Hilde Vandenneucker
- Department of Orthopaedics, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg-Lubbeek, Belgium,
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Saragaglia D, Mader R, Refaie R. Are results of total knee arthroplasty for isolated patellofemoral OA as good as for medial compartment OA? A medium-term retrospective comparative study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:381-6. [PMID: 25063527 DOI: 10.1007/s00590-014-1516-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 07/16/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to compare the results of isolated patellofemoral arthritis (IPFA) treated using a total knee arthroplasty (TKA) compared to the results of medial tibiofemoral arthritis treated with a TKA. We hypothesised that there would be no difference between functional outcomes for the two groups. METHODS Between 2003 and 2009, 32 TKAs were performed for IPFA (group I). Over this time period, a total of 813 primary TKAs were performed from which we identified a second group of patients who had undergone TKA for isolated medial tibiofemoral arthritis (group II: n = 32). These patients were matched based on age, sex, body mass index and average follow-up. The average age of patients in group I was 72.81 ± 6.6 years (59-83) and 71.97 ± 6.8 years in group II. The global International Knee Society (IKS) score was statistically significantly better in group I (114.72 ± 22 points) than in group II (84.9 ± 23.8). This difference was accounted for by better passive flexion, better walking distance and the absence of any coronal plane deformity. RESULTS A total of 29 patients from group I were reviewed at an average follow-up of 64.58 ± 23.4 months, and 30 patients in group II were reviewed at an average follow-up of 66.13 ± 23.9 months (three were lost to follow-up in group I and two in group II). At final follow-up, there was statistically no difference between the two groups IKS score (175.34 ± 19.26 in group I vs. 170.13 ± 24.14 for group II) or Hospital for Special Surgery patella score (89.31 ± 9.98 points for group I vs. 89.16 ± 11.45 points for group II). We found no significant radiological difference between the two groups including patella height and orientation on axial views. CONCLUSIONS The results of TKA for IPFA are as good as the results of TKA for isolated medial tibiofemoral arthritis with well-functioning prosthetic patellofemoral articulations. These results support our institutional preference for using TKA as treatment for IPFA in patients over 65-70 years old.
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Affiliation(s)
- D Saragaglia
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, Avenue de Kimberley, BP 338, 38434, Échirolles, France,
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12
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Abstract
Patellofemoral arthroplasty has a long record of use in the treatment of isolated patellofemoral arthritis, with outcomes influenced by patient selection, surgical technique, and trochlear implant design. The trochlear components have evolved from inlay-style to onlay-style designs, which have reduced the incidence of patellar instability. Minimizing the risk of patellar instability with onlay-design patellofemoral arthroplasties has enhanced mid-term and long-term results and leaves progressive tibiofemoral arthritis as the primary failure mechanism beyond 10 to 15 years.
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Affiliation(s)
- Jess H Lonner
- Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
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13
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Sangüesa Nebot MJ, Cabanes Soriano F, Fernández Gabarda R, Darder Prats A. [Dislocation of the polyethylene in a patello-femoral replacement with a movable patella]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 56:385-8. [PMID: 23594895 DOI: 10.1016/j.recot.2012.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 05/04/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022] Open
Abstract
Patellofemoral arthroplasty is an infrequently used surgical technique because of its controversial results. In an attempt to improve the results, a design with a mobile-bearing poliethylene patellar component has been developed. We describe a clinical case with an unusual complication: the dislocation of poliethylene from the metal backing; and accordingly, we carried out a literature review of this complication.
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Affiliation(s)
- M J Sangüesa Nebot
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Arnau de Vilanova, Valencia, España.
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Yadav B, Shaw D, Radcliffe G, Dachepalli S, Kluge W. Mobile-bearing, congruent patellofemoral prosthesis: short-term results. J Orthop Surg (Hong Kong) 2012; 20:348-52. [PMID: 23255644 DOI: 10.1177/230949901202000317] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To report the short-term outcome of the low contact stress (LCS) patellofemoral prosthesis in 51 knees. METHODS 12 men and 37 women aged 23 to 79 (mean, 53.4) years underwent 51 consecutive LCS patellofemoral replacements. All patients had symptomatic isolated arthritis in the patellofemoral joint with well-preserved tibiofemoral compartments. All knees were evaluated pre- and post-operatively. The new Oxford scoring system was used. Anteroposterior, lateral, and skyline weight-bearing radiographs were reviewed. RESULTS The mean follow-up period was 4.2 years; no patient was lost to follow-up. The mean new Oxford Knee score was 13.9 preoperatively and improved by 13.7 at 3 months (p<0.001) and by further 7.1 at 12 months (p<0.001). Any change after 12 months was not significant (p=0.73). 18 of the knees developed patellar maltracking and resulted in subluxation and lateral tilt of the patella with severe polyethylene wear. 10 (20%) of the knees were revised; 8 with patellar maltracking were revised to total knee arthroplasty (n=3) or patellofemoral arthroplasty with a different implant (n=5), whereas 2 with disease progression were revised to total knee arthroplasty. The estimated survival rate of the prosthesis was 73% at 4.5 years and 48% at 5.5 years. CONCLUSION The revision rate for the LCS patellofemoral prosthesis was high (20%).
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Affiliation(s)
- Basavaraj Yadav
- Bradford Royal Infirmary, Duckworth lane, Bradford, United Kingdom
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15
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Rath NK, Dudhniwala AG, White SP, Forster MC. Aseptic loosening of the patellar component at the cement-implant interface. Knee 2012; 19:823-6. [PMID: 22055643 DOI: 10.1016/j.knee.2011.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 08/08/2011] [Accepted: 08/30/2011] [Indexed: 02/02/2023]
Abstract
We present four cases of aseptic loosening at the implant-cement interface following patellar resurfacing. All patients initially had good results, but then presented with onset of a new anterior knee pain. The radiographs including flexed lateral and skyline view of the knee were normal in all the cases. After carefully ruling out infection, aseptic loosening at the cement-implant interface was diagnosed on further investigation. Aseptic loosening of the patellar button at the implant-cement interface can be difficult to diagnose with standard knee radiographs. During flexed lateral radiograph of the knee and the skyline view radiograph of the patellofemoral joint, the patella is compressed on the femur and thereby reducing the loose patellar button. This phenomenon has not been previously described. Patients presenting with new onset of knee pain after an initial good results following patellar resurfacing require further investigation to exclude loosening at the cement-implant interface as plain radiographs can be misleading.
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Affiliation(s)
- N K Rath
- The Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff, United Kingdom.
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Dislocation of the polyethylene in a patellofemoral replacement with a movable patella. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012. [DOI: 10.1016/j.recote.2012.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tarassoli P, Punwar S, Khan W, Johnstone D. Patellofemoral arthroplasty: a systematic review of the literature. Open Orthop J 2012; 6:340-7. [PMID: 22927894 PMCID: PMC3419872 DOI: 10.2174/1874325001206010340] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 02/19/2012] [Accepted: 03/10/2012] [Indexed: 11/22/2022] Open
Abstract
Identification and management of patients with isolated patellofemoral osteoarthritis are challenging. Many of these patients present at a young age and it is important to distinguish degenerative change in the patellofemoral articulation from the other various causes of anterior knee pain. Once the diagnosis of isolated patellofemoral arthrosis has been made non-operative and conservative surgical techniques should be exhausted fully before prosthetic arthroplasty is considered. This review focuses on the use of arthroplasty for isolated patellofemoral arthrosis, in particular comparing the use of total knee against selective patellofemoral joint replacements.
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Affiliation(s)
- Payam Tarassoli
- Bristol Royal Infirmary, Upper Maudlin St, Bristol, BS2 8HW, UK
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Mont MA, Johnson AJ, Naziri Q, Kolisek FR, Leadbetter WB. Patellofemoral arthroplasty: 7-year mean follow-up. J Arthroplasty 2012; 27:358-61. [PMID: 21964234 DOI: 10.1016/j.arth.2011.07.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 07/11/2011] [Indexed: 02/01/2023] Open
Abstract
Patellofemoral arthroplasty has had renewed interest with the purpose of this study to evaluate its outcomes. Between 2001 and 2006, 43 were performed in 37 patients who had a mean follow-up of 7 years (range, 4-8 years). Patient outcomes were determined using Knee Society objective and function scores, revision rates, and complication rates. The 5-year Kaplan-Meier survivorship was 95%. Knee Society objective scores improved from a mean of 64 points (range, 57-68 points) to 87 points (range, 50-100 points), and functional scores improved from a mean of 48 points (range, 45-50 points) to 82 points (range, 20-100 points). This study shows maintained successful clinical and radiographic results at mean 7-year follow-up for patellofemoral arthroplasty.
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Affiliation(s)
- Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, USA
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Charalambous CP, Abiddin Z, Mills SP, Rogers S, Sutton P, Parkinson R. The low contact stress patellofemoral replacement. ACTA ACUST UNITED AC 2011; 93:484-9. [DOI: 10.1302/0301-620x.93b4.25899] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The low contact stress patellofemoral replacement consists of a trochlear component and a modular patellar component which has a metal-backed mobile polyethylene bearing. We present the early results of the use of this prosthesis for established isolated patellofemoral arthritis in 51 consecutive patellofemoral replacements in 35 patients. The mean follow-up was 25 months (5 to 60). The estimated survival rate at three years was 63% (95% confidence interval 47 to 80) with revision as the endpoint and 46% (95% confidence interval 30 to 63) with revision and ongoing moderate or severe pain as the endpoint. The early results of the use of the low contact stress patellofemoral replacement are disappointing with a high rate of revision. We cannot therefore recommend its use.
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Affiliation(s)
| | - Z. Abiddin
- Doncaster Royal Infirmary, Armthorpe Road, Doncaster DN2 5LT, UK
| | - S. P. Mills
- Orthopaedic Department, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK
| | - S. Rogers
- Blackpool Victoria Hospital, Whinney Heys Road, Blackpool FY3 8NR, UK
| | - P. Sutton
- Knee Reconstruction Unit, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
| | - R. Parkinson
- Orthopaedic Department, Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Road, Upton, Wirral CH49 5PE, UK
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Long-term outcomes of patellofemoral arthroplasty. J Arthroplasty 2010; 25:1066-71. [PMID: 20056375 DOI: 10.1016/j.arth.2009.08.023] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 05/29/2009] [Accepted: 08/19/2009] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to correlate the long-term survival of patellofemoral arthroplasty with primary diagnosis, age, sex, and body mass index. One hundred eighty-five consecutive Richards type II patellofemoral arthroplasties were performed in 161 patients with isolated patellofemoral osteoarthritis. Diagnoses included primary patellofemoral osteoarthritis, posttraumatic patellofemoral osteoarthritis, and patellofemoral osteoarthritis with a previous realignment procedure for patellar subluxation or trochlear dysplasia. Median time to follow-up was 13.3 (range, 2.0-30.6) years. Patellofemoral arthroplasty survival was 84% at 10 years and 69% at 20 years. Primary diagnosis, sex, or age at patellofemoral arthroplasty did not significantly affect the rate of revision (P=.35, P=.24, and P=.65, respectively). The rate of revision in obese patients (body mass index>30 kg/m2) was higher than that in nonobese patients (P=.02).
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Abstract
BACKGROUND AND PURPOSE The optimal treatment for isolated patellofemoral osteoarthritis is unclear at present. We systematically reviewed the highest level of available evidence on the nonoperative and operative treatment of isolated patellofemoral osteoarthritis to develop an evidenced-based discussion of treatment options. METHODS A systematic computerized database search (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), and EMBASE) was performed in March 2009. The quality of the studies was assessed independently by two authors using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS We extracted data from 44 articles. The best available evidence for treatment of isolated patellofemoral osteoarthritis is sparse and of generally low methodological quality. Nonoperative treatment using physiotherapy (GRADE: high quality, weak recommendation for use), taping (GRADE: moderate quality, weak recommendation for use), or injection therapy (GRADE: very low quality, weak recommendation for use) may result in short-term relief. Joint-preserving surgical treatment may result in insufficient, unpredictable, or only short-term improvement (GRADE: low quality, weak recommendation against use). Total knee replacement with patellar resurfacing results in predictable and good, durable results (GRADE: low quality, weak recommendation for use). Outcome after patellofemoral arthroplasty in selected patients is good to excellent (GRADE: low quality, weak recommendation for use). INTERPRETATION Methodologically good quality comparative studies, preferably using a patient-relevant outcome instrument, are needed to establish the optimal treatment strategy for patients with isolated patellofemoral osteoarthritis.
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Affiliation(s)
| | - Rudolf W Poolman
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam
| | - Albert van Kampen
- Department of Orthopaedic Surgery and Orthopaedic Research Laboratory, Radboud University Nijmegen Medical Center, Nijmegenthe Netherlands
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22
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Starks I, Roberts S, White SH. The Avon patellofemoral joint replacement: independent assessment of early functional outcomes. ACTA ACUST UNITED AC 2010; 91:1579-82. [PMID: 19949120 DOI: 10.1302/0301-620x.91b12.23018] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present a prospective review of the two-year functional outcome of 37 Avon patellofemoral joint replacements carried out in 29 patients with a mean age of 66 years (30 to 82) between October 2002 and March 2007. No patients were lost to follow-up. This is the first independent assessment of this prosthesis using both subjective and objective analysis of outcome. At two years the median Oxford knee score was 39 (interquartile range 32 to 44), the median American Knee Society objective score was 95 (interquartile range 90 to 100), the median American Knee Society functional score was 85 (interquartile range 60 to 100), and the median Melbourne Knee score was 28 (interquartile range 21 to 30). Two patients underwent further surgery. Only one patient reported an unsatisfactory outcome. We conclude that the promising early results observed by the designing centre are reproducible and provide further support for the role of patellofemoral joint replacement.
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Affiliation(s)
- I Starks
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Shropshire, UK.
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Leadbetter WB, Mont MA. Patellofemoral Arthroplasty: A Useful Option for Recalcitrant Symptomatic Patellofemoral Arthritis. ACTA ACUST UNITED AC 2009. [DOI: 10.1053/j.sart.2009.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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van Jonbergen HPW, Werkman DM, Barnaart AF. Dissociation of mobile-bearing patellar component in low contact stress patellofemoral arthroplasty, its mechanism and management: two case reports. CASES JOURNAL 2009; 2:7502. [PMID: 19829980 PMCID: PMC2740181 DOI: 10.1186/1757-1626-2-7502] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 04/20/2009] [Indexed: 11/10/2022]
Abstract
Introduction Isolated patellofemoral osteoarthritis can be treated with patellofemoral arthroplasty. Case presentation We present two cases of isolated patellofemoral osteoarthritis treated with Low Contact Stress patellofemoral arthroplasty; in both cases the polyethylene mobile-bearing of the patellar component dissociated from the metal backing. One patient had a revision to a Richards patellofemoral prosthesis, and in the second patient the arthroplasty was converted to a total knee prosthesis because of clinically important femorotibial osteoarthritis. Conclusion The possible failure mechanisms are described. We suggest avoiding the use of a metal-backed mobile-bearing patellar component due to the risk of dissociation.
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Affiliation(s)
- Hans-Peter W van Jonbergen
- Department of Orthopaedic Surgery, Deventer Hospital Nico Bolkesteinlaan 75, 7416 SE Deventer The Netherlands.
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26
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Hofmann AA, Clark CD, Ponder C, Hoffman M. Patellofemoral Replacement: The Third Compartment. ACTA ACUST UNITED AC 2009. [DOI: 10.1053/j.sart.2008.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Confalonieri N, Manzotti A, Montironi F, Pullen C. Tissue sparing surgery in knee reconstruction: unicompartmental (UKA), patellofemoral (PFA), UKA + PFA, bi-unicompartmental (Bi-UKA) arthroplasties. J Orthop Traumatol 2008; 9:171-7. [PMID: 19384616 PMCID: PMC2656980 DOI: 10.1007/s10195-008-0015-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 05/12/2008] [Indexed: 01/17/2023] Open
Abstract
Recently mini-invasive joint replacement has become one of the hottest topics in the orthopaedic world. However, these terms have been improperly misunderstood as a "key-hole" surgery where traditional components are implanted with shorter surgical approaches, with few benefits and several possible dangers. Small implants as unicompartmental knee prostheses, patellofemoral prostheses and bi-unicompartmental knee prostheses might represent real less invasive procedures: Tissue sparing surgery, the Italian way to minimally invasive surgery (MIS). According to their experience the authors go through this real tissue sparing surgery not limited only to a small incision, but where the surgeons can respect the physiological joint biomechanics.
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Affiliation(s)
- N Confalonieri
- Ist Orthopaedic Department, Centro Traumatologico ed Ortopedico (C.T.O.), I.C.P., Via Bignami 1, 20100, Milan, Italy,
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[Isolated arthrosis of the patellofemoral joint in younger patients (<50 years)]. DER ORTHOPADE 2008; 37:848, 850-2, 854-7. [PMID: 18719888 DOI: 10.1007/s00132-008-1291-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the majority of cases, arthrosis of the patellofemoral joint (PFJ) is combined with arthrosis of the femorotibial compartment and thus assumes a somewhat secondary role. Nevertheless, it can occur as an isolated entity. Several radiological studies evidenced isolated degenerative alterations in the PFJ in the age group >55 years (13.6-24.0% in women and 11.0-15.4% in men). In younger patients the incidence is lower and is mainly associated with patellar instability or post-traumatic arthrosis. Just the same, the choice of appropriate treatment for these patients is challenging. Total replacement can be recommended for older and less active patients. In contrast, for younger and more active patients, various conservative treatment options and more demanding operative techniques are available to the surgeon to avoid arthroplasty. This article describes the different therapeutic possibilities for managing arthrosis of the PFJ in patients aged <50 years.
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Sisto DJ, Sarin VK. Patellofemoral arthroplasty with a customized trochlear prosthesis. Orthop Clin North Am 2008; 39:355-62, vi-vii. [PMID: 18602564 DOI: 10.1016/j.ocl.2008.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Successful patellofemoral arthroplasty depends on appropriate patient selection, proper prosthesis design, and correct surgical technique. Clinical results using off-the-shelf patellofemoral prostheses have reported mixed results primarily because of an inability to address these important characteristics adequately. This article reviews the design rationale, excellent clinical history, and straightforward surgical technique of a unique approach to patellofemoral arthroplasty that incorporates a customized trochlear prosthesis designed to fit the individual patient's patellofemoral groove. Clinical results using this customized approach demonstrate that it is a safe and effective treatment option for patients who have isolated patellofemoral arthritis.
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Affiliation(s)
- Domenick J Sisto
- Los Angeles Orthopaedic Institute, 4955 Van Nuys Boulevard, Suite 615, Sherman Oaks, CA 91403, USA.
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Abstract
The results of patellofemoral arthroplasty have been improved over the three decades that the procedure has been used for the treatment of patellofemoral arthritis. Specifically, there has been a reduction in the incidence of patellofemoral-related problems, such as patellar maltracking and catching, after patellofemoral arthroplasty. While these problems were often attributed to errors in surgical technique or component malposition, it is likely that many were related to flawed trochlear component designs. Contemporary patellofemoral arthroplasties have a reduced incidence of the problems related to patellar maltracking that typically plagued earlier generation designs. Further study will likely prove contemporary patellofemoral arthroplasty to be an effective treatment for the management of isolated patellofemoral arthritis, with predictable outcomes and a low incidence of complications.
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Delanois RE, McGrath MS, Ulrich SD, Marker DR, Seyler TM, Bonutti PM, Mont MA. Results of total knee replacement for isolated patellofemoral arthritis: when not to perform a patellofemoral arthroplasty. Orthop Clin North Am 2008; 39:381-8, vii. [PMID: 18602566 DOI: 10.1016/j.ocl.2008.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Many procedures have been used to treat advanced isolated patellofemoral arthritis, with varying results. Patellofemoral arthroplasty (PFA) is a bone-conserving procedure that has shown short-term success but has relatively high revision rates. Total knee arthroplasty (TKA) has been recommended for treatment of this disease in patients who are older than 60 years of age. Recent literature indicates that PFA is most successful in patients who have isolated patellofemoral arthritis secondary to trochlear dysplasia or patellar fracture and in patients who are younger than 60 years; TKA is recommended for older patients who have primary or idiopathic isolated patellofemoral arthritis.
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Affiliation(s)
- Ronald E Delanois
- Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
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Gadeyne S, Besse JL, Galand-Desme S, Lerat JL, Moyen B. Résultats de la prothèse fémoropatellaire autocentrique : à propos d’une série continue de 57 prothèses. ACTA ACUST UNITED AC 2008; 94:228-40. [DOI: 10.1016/j.rco.2007.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2007] [Indexed: 10/22/2022]
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Abstract
UNLABELLED Are the results of total knee arthroplasty for isolated patellofemoral osteoarthritis (OA) in younger patients as good as with patellofemoral arthroplasty? We retrospectively compared the outcomes of 33 TKAs in 27 patients with patellofemoral OA younger than 60 years of age (average, 52 years) to those for a matched group of patients with primarily tibiofemoral arthritis. A cemented posterior cruciate ligament-retaining prosthesis was used in 26 of the 27 knees. We recorded the intraoperative condition of the cartilage. Patients were followed a minimum of 2 years (average, 6.2 years). Average Knee Society knee scores improved from 49 preoperatively to 88 at final followup. Average pain scores from 5 to 44 with 29 knees rated with minimal or no pain; two patients reported anterior knee pain. There were no infections, revisions, reoperations, manipulations, patellar instabilities, patellar fractures, or component loosenings. The results in these patients were as good as those for younger historical control patients undergoing patellofemoral arthroplasty and the complication rates lower. The data were similar to those for our matched group of patients with primarily tibiofemoral OA. We believe our data should raise doubts about the use of patellofemoral arthroplasty in any patient. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Abstract
Patellofemoral arthroplasty can be an effective intermediate treatment for the patient with isolated arthritis of the anterior compartment of the knee. In the absence of patellar malalignment, results are optimized when an implant with sound geometric features is used, the prosthesis is appropriately aligned, and the soft tissues are balanced. Although previous prosthesis designs resulted in a relatively high prevalence of failure because of patellofemoral maltracking, patellofemoral catching, and anterior knee pain, newer prosthesis designs show promise in reducing the prevalence of patellofemoral dysfunction. Progressive tibiofemoral cartilage degeneration is another so-called failure mechanism; such progressive degeneration underscores the importance of restricting the procedure to patients who do not have tibiofemoral chondromalacia. Because long-term failure as a result of tibiofemoral degeneration may occur in approximately 25% of patients, patellofemoral arthroplasty may be considered an intermediate procedure for select patients with patellofemoral arthritis.
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Affiliation(s)
- Jess H Lonner
- Knee Replacement Surgery, Booth Bartolozzi Balderston Orthopaedics, Pennsylvania Hospital, Philadelphia, PA 19107, USA
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Morra EA, Greenwald AS. Patellofemoral replacement polymer stress during daily activities: a finite element study. J Bone Joint Surg Am 2006; 88 Suppl 4:213-6. [PMID: 17142450 DOI: 10.2106/jbjs.f.00585] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Edward A Morra
- Orthopaedic Research Laboratories, Lutheran Hospital, Cleveland Clinic Hospital, 1730 West 25th Street, Cleveland, OH 44113, USA
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Leadbetter WB, Seyler TM, Ragland PS, Mont MA. Indications, contraindications, and pitfalls of patellofemoral arthroplasty. J Bone Joint Surg Am 2006; 88 Suppl 4:122-37. [PMID: 17142442 DOI: 10.2106/jbjs.f.00856] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Wayne B Leadbetter
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
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Lonner JH, Jasko JG, Booth RE. Revision of a failed patellofemoral arthroplasty to a total knee arthroplasty. J Bone Joint Surg Am 2006; 88:2337-42. [PMID: 17079388 DOI: 10.2106/jbjs.f.00282] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patellofemoral arthroplasty is an effective treatment for isolated arthritis of the anterior compartment of the knee, but it is unclear whether it compromises the results of total knee arthroplasty if revision is necessary. The purpose of this study was to review the results of total knee arthroplasty after a prior patellofemoral arthroplasty. METHODS Twelve failed patellofemoral replacements in ten patients were revised to total knee arthroplasties for isolated progressive tibiofemoral arthritis (six knees), isolated patellofemoral catching and maltracking (three), or a combination of both (three). Revisions were performed at a mean of four years after the patellofemoral arthroplasty. A posterior stabilized implant was used in each knee, without a need for stems, augments, or structural bone graft. Patients were assessed by clinical and radiographic follow-up, including Knee Society clinical and functional scores. Baseline preoperative Knee Society scores were obtained at the time of evaluation of the failed patellofemoral arthroplasty. RESULTS At a mean follow-up of 3.1 years, the mean Knee Society clinical and functional scores had increased from 57 points preoperatively to 96 points and from 51 points preoperatively to 91 points, respectively. At the most recent follow-up, there was no clinical or radiographic evidence of patellofemoral maltracking, loosening, or wear. CONCLUSIONS On the basis of our experience in this relatively small series with short-term follow-up, the results of total knee arthroplasty do not seem to be compromised after revision of the failed patellofemoral replacement.
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Affiliation(s)
- Jess H Lonner
- Booth Bartolozzi Balderston Orthopaedics, Pennsylvania Hospital, 800 Spruce Street, Philadelphia, PA 19107, USA.
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Nicol SG, Loveridge JM, Weale AE, Ackroyd CE, Newman JH. Arthritis progression after patellofemoral joint replacement. Knee 2006; 13:290-5. [PMID: 16769215 DOI: 10.1016/j.knee.2006.04.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Accepted: 04/20/2006] [Indexed: 02/02/2023]
Abstract
Progressive symptomatic tibiofemoral osteoarthritis (OA) following patellofemoral joint replacement (PFJR) may necessitate revision to total knee arthroplasty. This study was designed to quantify this problem in a prospective series of 103 consecutive patients who underwent PFJRs undertaken at our institution. At a mean follow-up of 7.1 years (66-102 months), 14 knees (14%) have been revised, 12 of those (12%) because of the development of symptomatic tibiofemoral OA, with a mean time to revision of 55 months (range 14 to 95 months). Available radiographs of the 89 unrevised knees were subject to blinded and randomised assessment by two observers. Postoperative AP knee radiographs were scored to assess for tibiofemoral OA progression, with definite progression seen in a median of 7% of medial compartments but 0% of lateral compartments, over a mean period of 51 months. Sulcus angles on preoperative 30 degrees skyline radiographs were measured to assess for trochlear dysplasia. Seventeen percent of the knees without preoperative trochlear dysplasia have been revised for progression of tibiofemoral OA, compared to none of the knees with preoperative trochlear dysplasia. Furthermore, in the unrevised knees, statistically significantly more radiographic progression of tibiofemoral OA was seen in those without preoperative trochlear dysplasia (p = 0.01). Our results suggest that progressive tibiofemoral OA following PFJR is an important cause of failure, but it is seen significantly less frequently when the patellofemoral arthritis is secondary to dysplasia of the femoral trochlea, suggesting that these patients are the ideal candidates for PFJR.
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Affiliation(s)
- Steve G Nicol
- Winford Unit, Avon Orthopaedic Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK.
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Abstract
BACKGROUND The treatment of isolated patellofemoral arthritis is controversial. Several surgical procedures have been used to treat the severely degenerated patellofemoral joint, with varying degrees of success. The purpose of this study was to determine the clinical results of a custom patellofemoral arthroplasty for the treatment of isolated patellofemoral degenerative arthritis of the knee. METHODS From 1995 through 2002, twenty-five patellofemoral replacements, three of which were bilateral, were performed in twenty-two patients for the treatment of isolated patellofemoral arthritis of the knee. According to the Ahl-back radiographic evaluation scale, the mean preoperative score for the severity of the arthritis was 4.65 points in the patellofemoral compartment and 0.5 point in both the medial and the lateral compartment. The patients included sixteen women (two of whom had a bilateral replacement) and six men (one of whom had a bilateral replacement) with a mean age of forty-five years at the time of the index arthroplasty. Seventeen patients (nineteen knees) had had a prior procedure on the knee. The mean preoperative Knee Society functional score was 49 points, and the mean preoperative Knee Society objective score was 52 points. RESULTS At a mean of seventy-three months (range, thirty-two to 119 months) postoperatively, all twenty-five implants were in place and functioning well. There were eighteen excellent and seven good results. The mean Knee Society functional score was 89 points, and the mean Knee Society objective score was 91 points. No patient had required additional surgery or had component loosening. CONCLUSIONS On the basis of our relatively short-term follow-up study, custom patellofemoral arthroplasty appears to be a safe and effective treatment for isolated patellofemoral arthritis of the knee. We believe that the results presented in this paper justify the additional cost associated with the custom device. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
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Affiliation(s)
- Domenick J Sisto
- Los Angeles Orthopaedic Institute, 4955 Van Nuys Boulevard, Sherman Oaks, CA 91403, USA.
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