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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).
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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
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Morrison R, Mandalia V. Current outcomes of patellofemoral arthroplasty for isolated patellofemoral arthritis - A narrative review. J Orthop 2023; 46:156-160. [PMID: 37997600 PMCID: PMC10663639 DOI: 10.1016/j.jor.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/27/2023] [Accepted: 10/29/2023] [Indexed: 11/25/2023] Open
Abstract
Patellofemoral (PFJ) arthritis can be primary, or secondary to underlying trochlea dysplasia and patellofemoral malalignment. Although primary PFJ osteoarthritis affects an older patient population, just like tibiofemoral arthritis, it is common for younger patients to present with isolated PFJ arthritis secondary to an abnormal PFJ. PFJ arthroplasty (PFJA) has many benefits including being less invasive, associated with lower blood loss, is more cost-effective, and leaves the kinematics of the tibiofemoral joint undisturbed. As a result, there are arguably better functional outcomes associated with PFJA, however the historical revision rate of this procedure is high. Although registry outcome data associated with the first generation of PFJ implants shows a higher revision rate compared to TKA, the comparison of PFJ outcomes with TKA is not always age-matched and there is limited comparison on functional and patient-reported outcomes, something which is more important and relevant in a younger patient cohort. Improvements in implant design, instrumentation, surgical technique, and better patient selection has now resulted in outcomes which are comparable to that of TKA, and in some cases even better. This narrative review outlines the current outcomes of PFJA including highlighting factors which need to be considered in optimising outcomes, as well as discussing advanced techniques of robotic assisted PFJA.
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Affiliation(s)
- Rory Morrison
- Exeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Exeter, Devon, EX2 5DW, UK
| | - Vipul Mandalia
- Exeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Exeter, Devon, EX2 5DW, UK
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Shatrov J, Coolican MR. Isolated patellofemoral arthroplasty-surgical technique and tips: current concepts. J ISAKOS 2023:S2059-7754(23)00599-0. [PMID: 38029968 DOI: 10.1016/j.jisako.2023.11.009] [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: 08/31/2023] [Revised: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023]
Abstract
Successful patellofemoral arthroplasty (PFA) requires appropriate patient selection, correct implant positioning and attention to surgical technique. Whilst the original concept and rationale offered an attractive surgical option for patients with isolated patellofemoral arthritis, early results were disappointing and consequently many surgeons became reluctant to offer it. With newer-generation designs, outcomes have been more promising. However, attention to surgical technique remains an integral component to a successful outcome, with results being unforgiving when surgical errors are made. This paper explores the key components of the surgical technique in PFA, including implant design, patient selection and tips to avoid common mistakes.
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Affiliation(s)
- Jobe Shatrov
- Sydney Orthopaedic Research Institute (SORI) at Landmark Orthopaedics, St. Leonards, Sydney, 2065, Australia.
| | - Myles Rj Coolican
- Sydney Orthopaedic Research Institute (SORI) at Landmark Orthopaedics, St. Leonards, Sydney, 2065, Australia.
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Ennis HE, Phillips JLH, Jennings JM, Dennis DA. Patellofemoral Arthroplasty. J Am Acad Orthop Surg 2023; 31:1009-1017. [PMID: 37364255 DOI: 10.5435/jaaos-d-23-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
Patellofemoral arthroplasty (PFA) as a treatment option for isolated patellofemoral disease continues to evolve. Enhancement in patient selection, surgical technique, implant design, and technology has led to improved short-term and midterm outcomes. Furthermore, in the setting of a younger patient with isolated patellofemoral arthritis, PFA represents an option for improved function with faster recovery times, bone preservation, maintenance of ligamentous proprioception, and the ability to delay total knee arthroplasty (TKA). The most common reason for revising PFA to a TKA is progression of tibiofemoral arthritis. In general, conversion of PFA to TKA leads to successful outcomes with minimal bone loss and the ability to use primary TKA implants and instrumentation. PFA seems to be a cost-effective alternative to TKA in appropriately selected patients with 5-, 10-PFA survivorships of 91.7% and 83.3%, respectively, and an annual revision rate of 2.18%; however, more long-term clinical studies are needed to determine how new designs and technologies affect patient outcomes and implant performance.
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Affiliation(s)
- Hayley E Ennis
- From the Colorado Joint Replacement (Ennis, Phillips, Jennings, and Dennis), Department of Mechanical and Materials Engineering, University of Denver (Jennings, and Dennis), Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO (Dennis), and Department of Biomedical Engineering, University of Tennessee, Knoxville, TN (Dennis)
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Kunze KN, Palhares G, Uppstrom TJ, Hinkley P, Rizy M, Gomoll AH, Stein BES, Strickland SM. Establishing minimal detectable change thresholds for the international knee documentation committee and Kujala scores at one and two years after patellofemoral joint arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07341-y. [PMID: 36951980 DOI: 10.1007/s00167-023-07341-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/05/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE To define the minimal detectable change (MDC) for the international knee documentation committee (IKDC) and Kujala scores one and two years after patellofemoral joint arthroplasty (PFA). METHODS A distribution-based method (one-half the standard deviation of the mean difference between postoperative and preoperative outcome scores) was applied to establish MDC thresholds among 225 patients undergoing primary PFA at a single high-volume musculoskeletal-care center. Stability of change in MDC achievement was explored by quantifying the proportion of achievement at one- and two-year postoperative timepoints. Multivariable logistic regression analysis was performed to explore the association between sociodemographic and operative features on MDC achievement. RESULTS MDC thresholds for the Kujala score were 10.3 (71.1% achievement) and 10.6 (70.4% achievement) at one- and two years, respectively. The MDC thresholds for the IKDC score were 11.2 (78.1% achievement) and 12.3 (69.0% achievement) at one- and two years, respectively. Predictors of achieving the MDC for the Kujala and IKDC scores at both time points were lower preoperative Kujala and IKDC scores, respectively. Preoperative thresholds of ≤ 24.1 and 7.6 for the Kujala and IKDC scores, respectively, were associated with a 90% MDC achievement probability. When preoperative thresholds approached 64.3 and 48.3 for the Kujala and IKDC, respectively, MDC achievement probability reduced to 50%. CONCLUSION The MDC thresholds for the Kujala and IKDC scores two years after PFA were 10.6 and 12.3, respectively. Clinically significant health status changes were maintained overall, with a slight decrease in achievement rates between one and two years. MDC achievement was associated with disability at presentation, and several probability-based preoperative thresholds were defined. These findings may assist knee surgeons with patient selection and the decision to proceed with PFA by better understanding the patient-specific propensity for MDC achievement. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Guilherme Palhares
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Tyler J Uppstrom
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Paige Hinkley
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Morgan Rizy
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Andreas H Gomoll
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Beth E Shubin Stein
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Sabrina M Strickland
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Buyuk AF, Stannard JP, Rucinski K, Crecelius CR, Cook JL. The Missouri Osteochondral Preservation System Is Associated With Better Short-Term Outcomes Than Standard Preservation Methods When Performing Osteochondral Allograft Transplantation Using Shell Grafts for Patellofemoral Lesions. Arthroscopy 2023; 39:650-659. [PMID: 36306891 DOI: 10.1016/j.arthro.2022.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To compare outcomes after whole-surface osteochondral allograft (OCA) transplantation using shell grafts for treatment of patellofemoral joint lesions with respect to surfaces treated and OCA preservation method. METHODS With institutional review board approval and informed consent, patients were prospectively enrolled into a registry to follow outcomes after OCA transplantation. Patients who received patellofemoral shell OCA to treat the entire articular surface of the patella, trochlea, or both, and with a minimum of 2-year follow-up data, including patient-reported outcome measures (PROMs), failures, and complications, were included. Functional graft survival was determined based on patients returning to functional activities without need for OCA revision or arthroplasty surgery and calculated using the formula: 100% - (%revision + %failure). Minimum clinically important differences were determined based on previously validated data. Outcomes were compared based on differences in graft preservation methodology (Missouri Osteochondral Preservation System [MOPS] or standard preservation [SP]) and based on surfaces treated (patella, trochlea, or both). RESULTS Fifty-eight patients met inclusion criteria. Mean age was 36.7 years (range 15-60 years) and mean body mass index was 28.9 (range 18-42). OCAs stored using SP methods were transplanted in 12 patients, mean follow-up was (66.1 months; range 54-70 months): OCAs stored using MOPS methods were transplanted in 46 patients, mean follow-up was (44.8 months; range 24-60 months). Graft survival rate at final follow-up was significantly greater (P = .025) for MOPS OCAs (98%) compared with SP OCAs (75%), whereas 2-year functional graft survival rates (MOPS 98% vs SP 83%; P = .1) were not. Reoperation rate was significantly greater (P = .0014) for SP cases compared with MOPS cases. PROMs showed statistically significant and clinically meaningful improvements through 4 years after unipolar patella, unipolar trochlea, and bipolar patellofemoral OCA transplantation using MOPS grafts. Unipolar patella OCA transplantations were associated with significantly more reduction in pain and significantly better PROMs at 1-year compared with unipolar trochlea and bipolar patellofemoral OCAs. CONCLUSIONS OCA transplantation using MOPS shell grafts for unipolar and bipolar patellofemoral resurfacing was associated with statistically significant and clinically meaningful improvements from preoperative levels of pain and function. The 2-year functional graft survival rate was 83% in the SP group and 98% in the MOPS group, such that MOPS was associated with better short-term outcomes than SP methods when performing OCA transplantation using shell grafts for patellofemoral lesions. Patients who received unipolar patella allografts reported the best outcomes in terms of pain and function. LEVEL OF EVIDENCE Level III, retrospective analysis of registry data.
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Affiliation(s)
- Abdul Fettah Buyuk
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - Cory R Crecelius
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA.
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Wang Y, Bian Y, Qian W. Long-Term clinical results of patellofemoral arthroplasty for isolated patellofemoral osteoarthritis. J Orthop Surg (Hong Kong) 2023; 31:10225536231162832. [PMID: 36888931 DOI: 10.1177/10225536231162832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVES The aim of this study was to explore the clinical outcomes and long-term survival of patellofemoral arthroplasty in treatment of isolated patellofemoral osteoarthritis. METHODS We retrospectively studied a total of 46 type Y-L-Q PFAs that were designed at our institution in 38 patients. Implant survivorship was analyzed with a follow-up of 18.9-29.6 years. Knee Society Score (KSS), Oxford Knee Score (OKS), and University of California Los Angeles activity scale (UCLA) were used to assess functional outcomes. RESULTS The implant survivorship was 83.6% at 15 years, 76.8% at 20 years, and 59.4% at 25 years 14 PFAs in 12 patients were revised into total knee arthroplasty at 16.0 ± 6.7 years; 13 for progression of tibiofemoral osteoarthritis and one for polyethylene wear. The mean Knee Society Score objective scores and functional scores were 73.0 ± 17.5 (range, 49-95) and 56.4 ± 28.9 (range, 5-90), respectively. The mean Oxford Knee Score was 25.8 ± 11.5 (range, 8-44). CONCLUSION Type Y-L-Q patellofemoral arthroplasty can be an effective method for treating isolated patellofemoral osteoarthritis with satisfactory survival.
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Affiliation(s)
- Yiou Wang
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, 74698Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanyan Bian
- Department of Orthopedic Surgery, 34732Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenwei Qian
- Department of Orthopedic Surgery, 34732Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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