Obesity and the absence of trochlear dysplasia increase the risk of revision in patellofemoral arthroplasty

Liow, Ming Han Lincoln; Goh, Graham S.; Tay, Darren Keng Jin; Chia, Shi‐Lu; Lo, Ngai-Nung; Yeo, Seng-Jin

doi:10.1016/j.knee.2015.05.009

Cited by 47 publications

(36 citation statements)

References 32 publications

(35 reference statements)

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“…The revision rate for obese patients has been purported in previous literature to be higher than nonobese patients undergoing PFA. 6,7 One such study by Van Jonbergen et al identified a higher risk of revision in obese patients undergoing PFA. 7 Although the present study's results are not in agreement, the rate of revision PFA in the prior study was 24% overall, which was significantly higher than the current study.…”

Section: Discussionmentioning

confidence: 99%

Obesity Does Not Affect Patient-Reported Outcomes following Patellofemoral Arthroplasty

et al. 2020

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Patellofemoral arthroplasty (PFA) has garnered attention in recent years as an effective alternative to total knee arthroplasty for patients with symptomatic, isolated patellofemoral joint arthritis. Obesity has previously been identified as a risk factor for revision surgery, but its effect on patient-reported outcome measures (PROMs) has not been evaluated. A retrospective review of a consecutive series of PFA surgeries was conducted at a single, specialized orthopedics center in a major urban center. Patients were dichotomized by body mass index (BMI) as obese (O, BMI >30) or nonobese (NO, BMI: 18.5–25). Demographic, surgical information, and PROMs were collected and analyzed accordingly. Seventy-six patients (41 nonobese, 35 obese) were identified. Patients who were obese presented with significantly worse preoperative PROMs regarding knee-specific quality of life, physical function, and MH or mental health (knee injury and osteoarthritis outcome score quality of life [KOOS QoL], NO: 26.2, O: 14.7, p = 0.019; KOOS PF, NO: 38.2, O: 50.5, p = 0.002; Veterans Rand-12 mental health [VR-12 MH], NO: 54.2, O: 47.0, p = 0.033). No significant difference was seen in improvement in knee function scores between patients who were obese or nonobese (KOOS QoL, NO: 39.5, O: 40.6, p = 0.898; KOOS PS [physical function], NO: –17.8, O: –17.3, p = 0.945). Additionally, no difference in the rate of PFA revision was observed and there were no postoperative complications reported. Obese patients with isolated PFA can expect the same improvement in function as nonobese patients following patellofemoral joint arthroplasty. This paper underscores the priority of patient selection in PFA and challenges the notion that surgeons should exclude patients from receiving a PFA on the basis of obesity.

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Section: Discussionmentioning

confidence: 99%

Obesity Does Not Affect Patient-Reported Outcomes following Patellofemoral Arthroplasty

et al. 2020

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“…27 Lonner also advocated preoperative magnetic resonance imaging to assess the tibiofemoral compartments for evidence of chondral damage or reactive oedema. 28 Obesity with a BMI exceeding 30 kg/m 2 is considered a contraindication due to concern regarding overloading the prosthesis and increased propensity for osteoarthritic progression. This was corroborated by van Jonbergen who reported higher rates of revision in obese patients in a study of 185 Richards II prostheses.…”

Section: Brandmentioning

confidence: 99%

“…13 Similarly, in a study of 51 patients at 4 year follow-up, obesity was associated with reduced patient satisfaction and no significant improvement in the Melbourne Knee score. 28 Other contra-indications include patella baja, uncorrected tibiofemoral malalignment, fixed loss of knee range of motion and evidence of complex regional pain syndrome (Table 2).…”

Section: Brandmentioning

confidence: 99%

Patellofemoral arthroplasty: Current concepts

Cuthbert

Tibrewal

2018

Journal of Clinical Orthopaedics and Trauma

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Isolated patellofemoral arthritis (IPA) is a debilitating condition characterised by a loss of articular cartilage on the patella facets, the trochlear groove or both. By definition, patients with IPA must have normal cartilage in the tibiofemoral compartments of their knee. It is therefore logical to pursue arthroplasty which corrects the abnormality while sparing healthy bone and preserving the knee's native kinematics, which is the premise underpinning patellofemoral arthroplasty (PFA). However, its use remains controversial, with many surgeons still favouring total knee replacement (TKR) in these patients. This paper provides a comprehensive review of PFA in the literature to date and concludes, in carefully selected patients, PFA is worthy of consideration as a functionally superior and economically beneficial joint-preserving procedure - delaying TKR until implant failure or tibiofemoral osteoarthritis progression.

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“…Although OA of the knee is common, and approximately half of these patients have patellofemoral joint involvement, only 9% of patients with OA of the knee present with isolated patellofemoral arthritis [11,26]. When compared with TKA, PFR is performed in a population with a lower mean age and is more likely to be performed in women who have undergone prior surgical procedures; in addition, many patients have underlying trochlea or patella dysplasia [1,3,18,22,29]. The stated advantages of PFR include less blood loss, shorter hospital stay, preservation of bone and cruciate ligaments, and, in some series, better functional outcomes than TKA [6,24].…”

Section: Introductionmentioning

confidence: 99%

What Is the Risk of Repeat Revision When Patellofemoral Replacement Is Revised to TKA? An Analysis of 482 Cases From a Large National Arthroplasty Registry

Lewis

Graves

Cuthbert

et al. 2018

Clin Orthop Relat Res

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Background Patellofemoral replacements (PFRs) have a higher rate of revision than unicompartmental knee arthroplasty or TKA. However, there is little information regarding why PFRs are revised, the components used for these revisions, or the outcome of the revision procedure. Some contend that PFR is a bridging procedure that can easily be revised to a TKA with similar results as a primary TKA; however, others dispute this suggestion. Questions/purposes (1) In the setting of a large national registry, what were the reasons for revision of PFR to TKA and was the level of TKA constraint used in the revision associated with a subsequent risk of rerevision? (2) Is the risk of revision of the TKA used to revise a PFR greater than the risk of revision after a primary TKA and greater than the risk of rerevision after revision TKA? Methods Data were obtained from the Australian Orthopaedic Association Joint Replacement Registry through December 31, 2016, for TKA revision procedures after PFR. Because revisions for infection may be staged procedures resulting in further planned operations, for the revision analyses, these were excluded. There were 3251 PFRs, 482 of which were revised to TKA during the 17-year study period. The risk of

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Obesity and the absence of trochlear dysplasia increase the risk of revision in patellofemoral arthroplasty

Cited by 47 publications

References 32 publications

Obesity Does Not Affect Patient-Reported Outcomes following Patellofemoral Arthroplasty

Obesity Does Not Affect Patient-Reported Outcomes following Patellofemoral Arthroplasty

Patellofemoral arthroplasty: Current concepts

What Is the Risk of Repeat Revision When Patellofemoral Replacement Is Revised to TKA? An Analysis of 482 Cases From a Large National Arthroplasty Registry

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