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Baba R, Ohkoshi Y, Maeda T, Suzuki K, Iwadate A, Iwasaki K, Onodera T, Kondo E, Iwasaki N. The Influence of Patello-Femoral Overstuffing After Modular Unlinked Bicompartmental Knee Arthroplasty (BiKA) for Medial Tibio-Femoral and Patello-Femoral Osteoarthritis of the Knee. J Arthroplasty 2024; 39:638-644. [PMID: 37633506 DOI: 10.1016/j.arth.2023.08.069] [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: 04/26/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The factors affecting results after bicompartmental knee arthroplasty (BiKA) have not been fully elucidated. This major ligament-preserving procedure may be more susceptible to overstuffing of the patello-femoral (PF) joint than the major ligament-sacrificing total knee arthroplasty. Currently, we investigated the effect of PF overstuffing after BiKA on its clinical outcome. METHODS There were 71 patients (74 knees) who underwent modular unlinked BiKA at our clinic who had a follow-up of 5 to 9 years. Final follow-up results were assessed by evaluating knee range of motion, the 2011 Knee Society Score (2011KSS), Japanese Knee Osteoarthritis Measure, and radiological findings. The degree of postoperative PF overstuffing was evaluated by computed tomography and magnetic resonance images for 55 knees, and the correlation between the degree of overstuffing and postoperative clinical results were examined. RESULTS Overall clinical results improved significantly after surgery without any revision cases. The X-ray measurements showed the improved coronal alignments and the appropriate implant installation angles. Higher degree of postoperative PF overstuffing caused by insufficient amount of osteotomy on the anterior surface of the femur correlated with worse postoperative total 2011KSS at 2 years after surgery (Spearman's rank correlation coefficient (rs) = -0.387, P = .004), as opposed to no correlation at the time of the final follow-up (Spearman's rank correlation coefficient = 0.068, P = .623). CONCLUSION Modular unlinked BiKA provided patients with a high level of satisfaction and functional improvement over 5 to 9 years postoperatively. However, because PF overstuffing affects initial patient satisfaction, the amount of osteotomy should be determined carefully during the surgery.
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Affiliation(s)
- Rikiya Baba
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan; Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasumitsu Ohkoshi
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Tatsunori Maeda
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Ko Suzuki
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Akane Iwadate
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Koji Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Sava MP, Neopoulos G, Leica A, Hirschmann MT. Patellofemoral arthroplasty with onlay prosthesis leads to higher rates of osteoarthritis progression than inlay design implants: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:3927-3940. [PMID: 37005940 PMCID: PMC10435614 DOI: 10.1007/s00167-023-07404-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE The aim of this study was to report the clinical and functional outcomes, complication rates, implant survivorship and the progression of tibiofemoral osteoarthritis (OA), after new inlay or onlay patellofemoral arthroplasty (PFA), for isolated patellofemoral OA. Comparison of different implant types and models, where it was possible, also represented one of the objectives. METHODS A systematic literature search following PRISMA guidelines was conducted on PubMed, Scopus, Embase and Cochrane databases, to identify possible relevant studies, published from the inception of these databases until 11.11.2022. Randomized control trials (RCTs), case series, case control studies and cohort studies, written in English or German, and published in peer-reviewed journals after 2010, were included. Not original studies, case reports, simulation studies, systematic reviews, or studies that included patients who underwent TKA or unicompartmental arthroplasty (UKA) of the medial or lateral compartment of the knee, were excluded. Additionally, only articles that assessed functional and/or clinical outcomes, patient-reported outcomes (PROMs), radiographic progression of OA, complication rates, implant survival rates, pain, as well as conversion to TKA rates in patients treated with PFA, using inlay or onlay trochlea designs, were included. For quality assessment, the Methodological Index for Non-Randomized Studies (MINORS) for non-comparative and comparative clinical intervention studies was used. RESULTS The literature search identified 404 articles. 29 of them met all the inclusion criteria following the selection process. Median MINORS for non-comparative studies value was 12.5 (range 11-14), and for comparative studies 20.1 (range 17-24). In terms of clinical and functional outcomes, no difference between onlay and inlay PFA has been described. Both designs yielded satisfactory results at short, medium and long-term follow-ups. Both designs improved pain postoperatively and no difference between them in terms of postoperative VAS has been noted, although the onlay groups presented a higher preoperative VAS. When comparing the inlay to onlay trochlea designs, the inlay group displayed a lower progression of OA rate. CONCLUSION There is no difference in functional or clinical outcomes after PFA between the new inlay and the onlay designs, with both presenting an improvement in most of the scores that were used. A higher rate of OA progression was observed in the onlay design group. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Manuel-Paul Sava
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (BruderholzLiestalLaufen), CH-4101, Bruderholz, Switzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine and Biomechanics, University of Basel, CH-4001, Basel, Switzerland
| | - Georgios Neopoulos
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (BruderholzLiestalLaufen), CH-4101, Bruderholz, Switzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine and Biomechanics, University of Basel, CH-4001, Basel, Switzerland
| | - Alexandra Leica
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (BruderholzLiestalLaufen), CH-4101, Bruderholz, Switzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine and Biomechanics, University of Basel, CH-4001, Basel, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (BruderholzLiestalLaufen), CH-4101, Bruderholz, Switzerland.
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine and Biomechanics, University of Basel, CH-4001, Basel, Switzerland.
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Aweid O, Ahearn N, Metcalfe AJ, Eldridge J, Porteous A, Murray JR, Eldridge J, Robinson J, Murray J, Davies H, Howells N, Clark D, Putnis S, Hassaballa M, Bray R, Negrut C, MacDonald K, Miller S. A radiological index that influences the outcome following patellofemoral joint arthroplasty: the anterior trochlea offset ratio. Knee Surg Sports Traumatol Arthrosc 2022; 31:1412-1419. [PMID: 36098748 PMCID: PMC10049942 DOI: 10.1007/s00167-022-07085-1] [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: 03/29/2022] [Accepted: 07/24/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Although largely successful, patellofemoral joint arthroplasty (PFA) has a less than satisfactory outcome in some patients. It was hypothesized that certain factors can be identified on radiological review that correlate with poor patient reported outcomes following PFA. METHODS A retrospective cohort review of 369 patients undergoing PFA at our institution between 2005 and 2018 identified 43 "poor outcome" patients with an Oxford Knee Score (OKS) of less than 20 at 2 years follow up. These cases were matched by sex and age with 43 "good outcome" patients who had an OKS above 40 at 2 years post-op. Multiple radiological measurements were performed including anterior trochlea offset ratio (ATOR), component flexion/extension, component varus/valgus, component to bone width ratio and retinacular index. The OKS PROM was the primary outcome of the study. Stepwise logistic regression was performed to analyze the differences in radiological indices between the two groups. RESULTS Intraclass correlation coefficients for inter-observer and intra-observer reliability were 0.90-0.98 for all indices measured. The only index demonstrating statistical significance between the groups was the ATOR (p = 0.003). The good outcome group had a mean ATOR of 0.19 whereas the poor outcome group had a mean ATOR of 0.24. CONCLUSIONS Lower ATOR on radiological review was strongly associated with improved outcomes following PFA. The surgeon should therefore take particular care to prevent increasing the anterior offset of the trochlea component when performing PFA. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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Affiliation(s)
- Osama Aweid
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Nathanael Ahearn
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, BS10 5NB, UK
| | | | | | - Andrew Porteous
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, BS10 5NB, UK
| | - James R Murray
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, BS10 5NB, UK.
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Benignus C, Meier M, Best R, Beckmann J. [When nothing else works: patellofemoral joint arthroplasty]. SPORTVERLETZUNG-SPORTSCHADEN 2021; 35:227-233. [PMID: 34883522 DOI: 10.1055/a-1523-9937] [Citation(s) in RCA: 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.
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Mochizuki T, Yano K, Ikari K, Okazaki K. Difference in patient-reported outcomes of various patellar component designs in total knee arthroplasty: A randomized clinical study. J Orthop Surg (Hong Kong) 2021; 29:2309499021996068. [PMID: 33629887 DOI: 10.1177/2309499021996068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This study investigated the clinical effects of different patellar components without being affected by the femoral component design in total knee arthritis (TKA) for patients with knee osteoarthritis (OA). METHODS In total, 48 patients with OA who met the criteria of the American College of Rheumatology for OA were enrolled and randomly assigned in a 1:1 ratio to two groups according to the usage of patellar component design for TKA (medialized dome type [dome group] or medialized anatomic type [anatomic group]). To evaluate the clinical outcomes for TKA, knee range of motion (ROM), pain intensity of 0-100 mm visual analog scale (pain VAS), and the Japanese Knee Osteoarthritis Measure (JKOM) score were obtained at baseline and year 1. RESULTS The difference in knee ROM, pain VAS, or total JKOM score at year 1 was not significant between the dome and anatomic groups (p = 0.398, 0.733 and 0.536, respectively). Moreover, similar results were obtained for changes in knee ROM, pain VAS, or total JKOM scores from baseline. In both groups, the pain VAS and total JKOM scores were significantly improved at year 1. CONCLUSION Both dome and anatomic groups in TKA are significantly effective for pain and function using the JKOM score. However, their efficacy did not differ, according to the JKOM score. Results of this study are rare information focusing on the patellar component design and provide one of the insights into the TKA clinical management.
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Affiliation(s)
- Takeshi Mochizuki
- Department of Orthopaedic Surgery, Kamagaya General Hospital, Chiba, Japan
| | - Koichiro Yano
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Keshmiri A, Dirisamer F, Liebensteiner M, El Attal R, Pagenstert G, Seitlinger G, Wagner D, Balcarek P, Kappel P, Schöttle P, Frings J, Tscholl P, Becher C. Operative Treatment Options for Patellofemoral Arthritis: An Expert Recommendation of the AGA Patellofemoral Committee. Orthop J Sports Med 2021; 9:2325967121994849. [PMID: 33855097 PMCID: PMC8013641 DOI: 10.1177/2325967121994849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/02/2020] [Indexed: 11/17/2022] Open
Abstract
Background: The operative therapy of patellofemoral arthritis requires an individual approach depending on the underlying injury. However, the literature lacks recommendations for its course of action. Purpose: To generate an expert recommendation of therapy for different patellofemoral abnormalities in patients suffering from isolated patellofemoral arthritis. Study Design: Consensus statement. Methods: To generate recommendations, the AGA Patellofemoral Committee performed a consensus process using the Delphi method based on the available literature on isolated patellofemoral arthritis. Results: In most statements and recommendations, a high percentage of consensus could be found. However, also in the expert group of the AGA Patellofemoral Committee, some controversies on the treatment of patellofemoral arthritis exist. Conclusion: The operative therapy of isolated patellofemoral arthritis is a challenging topic that leads to controversial discussions, even in an expert group. With this consensus statement of the AGA Patellofemoral Committee, recommendations on different operative treatment options were able to be generated, which should be considered in clinical practice.
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Affiliation(s)
- Armin Keshmiri
- Armin Keshmiri, MD, PhD, MVZ im Helios, Helene-Weber-Allee 19, München 80637, Germany ()
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Patellofemorale Arthrose. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00379-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
AIMS A pragmatic, single-centre, double-blind randomized clinical trial was conducted in a NHS teaching hospital to evaluate whether there is a difference in functional knee scores, quality-of-life outcome assessments, and complications at one-year after intervention between total knee arthroplasty (TKA) and patellofemoral arthroplasty (PFA) in patients with severe isolated patellofemoral arthritis. METHODS This parallel, two-arm, superiority trial was powered at 80%, and involved 64 patients with severe isolated patellofemoral arthritis. The primary outcome measure was the functional section of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 12 months. Secondary outcomes were the full 24-item WOMAC, Oxford Knee Score (OKS), American Knee Society Score (AKSS), EuroQol five dimension (EQ-5D) quality-of-life score, the University of California, Los Angeles (UCLA) Physical Activity Rating Scale, and complication rates collected at three, six, and 12 months. For longer-term follow-up, OKS, EQ-5D, and self-reported satisfaction score were collected at 24 and 60 months. RESULTS Among 64 patients who were randomized, five patients did not receive the allocated intervention, three withdrew, and one declined the intervention. There were no statistically significant differences in the patients' WOMAC function score at 12 months (adjusted mean difference, -1.2 (95% confidence interval -9.19 to 6.80); p = 0.765). There were no clinically significant differences in the secondary outcomes. Complication rates were comparable (superficial surgical site infections, four in the PFA group versus five in the TKA group). There were no statistically significant differences in the patients' OKS score at 24 and 60 months or self-reported satisfaction score or pain-free years. CONCLUSION Among patients with severe isolated patellofemoral arthritis, this study found similar functional outcome at 12 months and mid-term in the use of PFA compared with TKA. Cite this article: Bone Joint J 2020;102-B(3):310-318.
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Affiliation(s)
- Michelle N Joseph
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Juul Achten
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nick R Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Matthew L Costa
- University of Oxford Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Bunyoz KI, Lustig S, Troelsen A. Similar postoperative patient-reported outcome in both second generation patellofemoral arthroplasty and total knee arthroplasty for treatment of isolated patellofemoral osteoarthritis: a systematic review. Knee Surg Sports Traumatol Arthrosc 2019; 27:2226-2237. [PMID: 30264243 DOI: 10.1007/s00167-018-5151-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Due to inconsistent results and high failure rates, total knee arthroplasty (TKA) is more often used to treat isolated patellofemoral osteoarthritis (PFOA) despite the theoretical advantage of patellofemoral arthroplasty (PFA). It is perceived that second-generation PFA may have improved the outcomes of surgery. In this systematic review, the primary aim was to compare outcomes of second-generation PFA and TKA by assessment of patient-reported outcome measures (PROMs). METHODS A systematic search was made in PubMed, Medline, Embase, Cinahl, Web of Science, Cochrane Library and MeSH to identify studies using second-generation PFA implants or TKA for treatment of PFOA. Only studies using The American Knee Society (AKSS), The Oxford Knee Score (OKS) or The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to report on PROMs were included. RESULTS The postoperative weighted mean AKSS knee scores were 88.6 in the second-generation PFA group and 91.8 in the TKA group. The postoperative weighted mean AKSS function score was 79.5 in the second-generation PFA group and 86.4 in the TKA group. There was no significant difference in the mean AKSS knee or function scores between the second-generation PFA group and the TKA group. The postoperative weighted mean OKS score was 36.7 and the postoperative weighted mean WOMAC score was 24.4. The revision rate was higher in the second-generation PFA group (113 revisions [8.4%]) than in the TKA group (3 revisions [1.3%]). Progression of OA was most commonly noted as the reason for revision of PFA, and it was noted in 60 cases [53.1%]; this was followed by pain in 33 cases [29.2%]. CONCLUSION Excellent postoperative weighted mean AKSS knee scores were found in both the second-generation PFA group and in the TKA group, suggesting that both surgical options can result in a satisfying patient-reported outcome. Higher revision rates in the second-generation PFA studies may in part be due to challenges related to patient selection. Based on evaluation of PROMs, the use of second-generation PFA seems to be an equal option to TKA for treatment of isolated PFOA in appropriately selected patients. Hopefully, this can be considered by physicians in their daily clinical work. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Sébastien Lustig
- Service de chirurgie orthopédique, Centre Albert-Trillat, CHU de Lyon-Nord, Lyon, France
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, 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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Stryker LS, Odum SM, Springer BD, Fehring TK. Role of Patellofemoral Offset in Total Knee Arthroplasty: A Randomized Trial. Orthop Clin North Am 2017; 48:1-7. [PMID: 27886678 DOI: 10.1016/j.ocl.2016.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Total knee arthroplasty occasionally does not meet expectations. This randomized clinical trial assessed the effect of restoration of the native patellofemoral height on clinical outcomes. Group I underwent standard patellar bone resection; group II underwent modified patellar bone resection that adjusted the amount of anterior condylar bone removed and the anterior flange thickness. There were no differences in anterior knee pain, Western Ontario and McMaster Universities Arthritis Index scores, or Knee Injury and Osteoarthritis Outcome Score scores. Patellofemoral compartment height restoration versus patellar height alone does not appear to significantly reduce pain or improve function.
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Affiliation(s)
- Louis S Stryker
- Joint Reconstruction, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, MSC-7774, San Antonio, TX 78229, USA
| | - Susan M Odum
- OrthoCarolina Research Institute, 2001 Vail Avenue, Suite 300, Charlotte, NC 28207, USA
| | - Bryan D Springer
- OrthoCarolina Hip & Knee Center, 2001 Vail Avenue, Suite 200A, Charlotte, NC 28207, USA.
| | - Thomas K Fehring
- OrthoCarolina Hip & Knee Center, 2001 Vail Avenue, Suite 200A, Charlotte, NC 28207, USA
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12
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Sabatini L, Schirò M, Atzori F, Ferrero G, Massè A. Patellofemoral Joint Arthroplasty: Our Experience in Isolated Patellofemoral and Bicompartmental Arthritic Knees. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2016; 9:189-193. [PMID: 27891054 PMCID: PMC5111569 DOI: 10.4137/cmamd.s40498] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/10/2016] [Accepted: 10/16/2016] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Isolated patellofemoral (PF) arthritis is rare, and there is no complete agreement about the best surgical treatment. The operative treatments are total knee arthroplasty and patellofemoral replacement (PFR). The incidence of many early complications of PF arthroplasty has decreased with the introduction of newer designs. Nowadays, the main cause of revision surgery is the progression of tibiofemoral osteoarthritis. In the past, PF arthroplasty was contraindicated in patients with evidence of osteoarthritis or pain in medial or lateral tibiofemoral compartments. The improvement in implant designs and surgical techniques has allowed the addition of a monocompartmental arthroplasty for the medial or lateral tibiofemoral compartment. In this work, we evaluate our first experience with PF arthroplasty and its combination with unicompartmental knee arthroplasty. MATERIALS AND METHODS From May 2014 to March 2016, we treated 14 patients. An isolated PF arthroplasty was performed in six knees (five patients), and a combined PF and unicompartmental knee arthroplasty was performed in nine cases. We observed a significant improvement in the clinical and functional Knee Society Scores (KSSs) after surgery in our patients. RESULTS We obtained good results in our cases both for clinical and functional KSSs. Patellar clunk was recorded in one case. DISCUSSION AND CONCLUSION We are going toward a new attitude in which partial osteoarthritic changes could be treated with partial resurfacing prosthetic solutions such as unicompartmental, bi–unicompartmental or PFR alone, or unicompartmental combined, which respects the cruciates and achieves maximal bone preservation, which is vital, particularly, for young patients.
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Affiliation(s)
- L Sabatini
- Department of Orthopaedics and Traumatology, San Luigi Hospital of Orbassano, University of Turin, Torino, Italy
| | - M Schirò
- University of Study of Turin, Turin, Italy
| | - F Atzori
- Department of Orthopaedics, Cottolengo Hospital, Torino, Italy
| | - G Ferrero
- Department of Orthopaedics and Traumatology, San Luigi Hospital of Orbassano, University of Turin, Torino, Italy
| | - A Massè
- Department of Orthopaedics Citta della Salute e della Scienza, PO CTO, University of Study of Turin, Torino, Italy
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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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14
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Abstract
Patellofemoral arthroplasty remains controversial, primarily due to the high failure rates reported with early implants. Several case series have been published over the years, which describe the results with various first- and second-generation implants. The purpose of this work was to summarize results published up to now and identify common themes for implants, surgical techniques, and indications. First-generation resurfacing implants had relatively high failure rates in the medium term. Second-generation implants, with femoral cuts based on TKA designs, have yielded more promising medium-term results. The surgical indications are quite specific and must be chosen carefully to minimize poor results. Short-term complications are generally related to patellar maltracking, while long-term complications are generally related to progression of osteoarthritis in the tibiofemoral joint. Implant loosening and polyethylene wear are rare. Overall, recent improvements in implant design and surgical techniques have resulted in better short- and medium-term results. But more work is required to assess the long-term outcomes of modern implant designs.
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Affiliation(s)
- S Lustig
- Service de chirurgie orthopédique, Centre Albert-Trillat, CHU de Lyon-Nord, Lyon, France.
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15
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Williams DP, Pandit HG, Athanasou NA, Murray DW, Gibbons CLMH. Early revisions of the Femoro-Patella Vialla joint replacement. Bone Joint J 2013; 95-B:793-7. [PMID: 23723274 DOI: 10.1302/0301-620x.95b6.31355] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim of this study was to review the early outcome of the Femoro-Patella Vialla (FPV) joint replacement. A total of 48 consecutive FPVs were implanted between December 2007 and June 2011. Case-note analysis was performed to evaluate the indications, operative histology, operative findings, post-operative complications and reasons for revision. The mean age of the patients was 63.3 years (48.2 to 81.0) and the mean follow-up was 25.0 months (6.1 to 48.9). Revision was performed in seven (14.6%) at a mean of 21.7 months, and there was one re-revision. Persistent pain was observed in three further patients who remain unrevised. The reasons for revision were pain due to progressive tibiofemoral disease in five, inflammatory arthritis in one, and patellar fracture following trauma in one. No failures were related to the implant or the technique. Trochlear dysplasia was associated with a significantly lower rate of revision (5.9% vs 35.7%, p = 0.017) and a lower incidence of revision or persistent pain (11.8% vs 42.9%, p = 0.045). Focal patellofemoral osteoarthritis secondary to trochlear dysplasia should be considered the best indication for patellofemoral replacement. Standardised radiological imaging, with MRI to exclude overt tibiofemoral disease should be part of the pre-operative assessment, especially for the non-dysplastic knee.
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Affiliation(s)
- D P Williams
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK.
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