Patellofemoral arthritis treated with resurfacing implant: Clinical outcome and complications at a minimum two-year follow-up

Zicaro, Juan Pablo; Yacuzzi, Carlos; Bonorino, Juan Astoul; Carbó, Lisandro; Paz, Matías Costa

doi:10.1016/j.knee.2017.09.003

Cited by 22 publications

(22 citation statements)

References 23 publications

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“…In the case of ROM, 12 studies were identified for data extraction. The majority of the studies reported an increase in the postoperative ROM when compared to preoperative values [1, 12, 19, 24, 27, 35, 38, 43, 50]. Contrary to the majority, Al‐Hadithy et al reported no change in ROM, when comparing preoperative values to 12‐months follow‐up ones [4].…”

Section: Resultsmentioning

confidence: 99%

“…In total, 19 studies were identified [1–3, 5, 7, 10, 19, 22, 24, 25, 30, 32, 36, 38, 40, 42, 43, 49, 50]. Complication rates varied greatly among analysed studies, from as low as 0.0% [25, 36] to as high as 35.3% [49] or even 41.2% [50]. The most commonly reported complication was patellar maltracking, followed closely by anterior knee pain [1–3, 5, 7, 10, 19, 22, 24, 30, 32, 38, 42, 43, 49, 50].…”

Section: Resultsmentioning

confidence: 99%

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Patellofemoral arthroplasty with onlay prosthesis leads to higher rates of osteoarthritis progression than inlay design implants: a systematic review

Sava

Neopoulos

Leica

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Patellofemoral arthroplasty with onlay prosthesis leads to higher rates of osteoarthritis progression than inlay design implants: a systematic review

Sava

Neopoulos

Leica

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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“…Regarding the results of the risk factor assessment, the presence of concomitant procedures addressing patellofemoral instability or malalignment as risk factors for failure are in line with previously published failure analyses. Moreover, previous investigations on patellofemoral malalignment in PFIA found patella alta and patellar subluxation [ 1 ] as well as patellofemoral maltracking [ 36 ] to be predictive for failure. In the large collective of this study, these findings could be extended to the general necessity for concomitant procedures addressing patellofemoral instability or maltracking.…”

Section: Discussionmentioning

confidence: 99%

The lack of retropatellar resurfacing at index surgery is significantly associated with failure in patients following patellofemoral inlay arthroplasty: a multi-center study of more than 260 patients

Imhoff

Bartsch

Behrens³

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the clinical outcomes of patients with a minimum 2-year follow-up following contemporary patellofemoral inlay arthroplasty (PFIA) and to identify potential risk factors for failure in a multi-center study. Methods All patients who underwent implantation of PFIA between 09/2009 and 11/2016 at 11 specialized orthopedic referral centers were enrolled in the study and were evaluated retrospectively at a minimum 2-year follow-up. Clinical outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tegner Scale, the visual analogue scale (VAS) for pain, and subjective patient satisfaction. Pre- and perioperative risk factors were compared among failures and non-failures to determine potential risk factors. Results A total of 263 patients (85% follow-up rate) could be enrolled. The mean age at the time of index surgery was 49 ± 12 years with a mean postoperative follow-up of 45 ± 18 months. The overall failure rate was 11% (28 patients), of which 18% (5 patients) were patients with patella resurfacing at index surgery and 82% (23 patients) were patients without initial patella resurfacing. At final follow-up, 93% of the patients who did not fail were satisfied with the procedure with a mean transformed WOMAC Score of 84.5 ± 14.5 points, a mean KOOS Score of 73.3 ± 17.1 points, a mean Tegner Score of 3.4 ± 1.4 points and a mean VAS pain of 2.4 ± 2.0 points. An increased BMI was significantly correlated with a worse postoperative outcome. Concomitant procedures addressing patellofemoral instability or malalignment, the lack of patellofemoral resurfacing at the index surgery and a high BMI were significantly correlated with failure in our patient cohort. Conclusion Patellofemoral inlay arthroplasty shows high patient satisfaction with good functional outcomes at short-term follow-up and thus can be considered a viable treatment option in young patients suffering from isolated patellofemoral arthritis. Patellar resurfacing at index surgery is recommended to decrease the risk of failure. Level of evidence Retrospective case series, Level IV.

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“…Das patellare Alignment stellt wegen fehlender Landmarken und Dysplasien eine große Herausforderung dar. Während sich eine patellofemorale Arthrose ohne patellofemorale Instabilität eher leicht wiederherstellen lässt, sind Patienten mit Dysplasien und eventuell zusätzlicher Instabilität selbst für geübte Operateure eine Herausforderung 22 . Zur Vermeidung von patellarem Maltracking und Instabilität ist das Trochleaimplantat häufig in Valgus (vor allem beim weiblichen Geschlecht) und Außenrotation zur transepikondylären Achse zu implantieren.…”

Section: Planung Und Vorgehenunclassified

Wenn nichts mehr geht: Der patellofemorale Gelenkersatz

Benignus

Meier

Best

et al. 2021

Sportverletz Sportschaden

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ZusammenfassungDer patellofemorale Gelenkersatz stellt die beste verfügbare Therapieoption bei isolierter patellofemoraler Arthrose dar. Vor allem junge Patienten sollten mit möglichst knochensparender Technik unter Erhalt der Weichteile operiert werden, da sie mit hoher Wahrscheinlichkeit im Verlauf des Lebens revidiert werden. Die korrekte Patientenselektion ist wichtig für den Operationserfolg und sollte sowohl eine gründliche klinische Untersuchung als auch Bildgebung beinhalten. Hier ist vor allem auf zusätzliche Pathologien zu achten, die eventuell ebenfalls adressiert werden müssen. Für die Trochlea gibt es mit dem Inlay- und Onlay-System 2 verschiedene moderne Möglichkeiten der Versorgung. Ein Ersatz der retropatellaren Fläche sollte regelhaft erfolgen. Der patellofemorale Gelenkersatz wird immer noch selten durchgeführt, sodass eine Behandlung in spezialisierten Zentren empfohlen wird. Daten aus Endoprothesenregistern zeigen hohe Revisionsraten, während Daten aus Zentren vielversprechende Ergebnisse aufweisen.

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Patellofemoral arthritis treated with resurfacing implant: Clinical outcome and complications at a minimum two-year follow-up

Cited by 22 publications

References 23 publications

Patellofemoral arthroplasty with onlay prosthesis leads to higher rates of osteoarthritis progression than inlay design implants: a systematic review

Patellofemoral arthroplasty with onlay prosthesis leads to higher rates of osteoarthritis progression than inlay design implants: a systematic review

The lack of retropatellar resurfacing at index surgery is significantly associated with failure in patients following patellofemoral inlay arthroplasty: a multi-center study of more than 260 patients

Wenn nichts mehr geht: Der patellofemorale Gelenkersatz

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