Patellofemoral replacement

Abstract

Isolated patellofemoral arthritis is a common condition and there are varying opinions on the most effective treatments. Non-operative and operative treatments have failed to demonstrate effective long-term treatment for those in an advanced stage of the condition. Newer designs and increased technology in patellofemoral replacement (PFR) have produced more consistent outcomes. This has led to a renewed enthusiasm for this procedure. Newer PFR prostheses have addressed the patellar maltracking issues plaguing some of the older designs. Short-term results with contemporary prostheses and new technology are described here.

Survivorship and functional outcomes of patellofemoral arthroplasty: a systematic review

“…1). Twenty‐three cohort studies [1–3, 6, 16–18, 20, 32, 33, 39, 40, 50, 57, 64, 70, 71, 75, 84, 88, 92, 96, 102] and one registry [4] reported survivorship using Kaplan–Meier analysis. Forty‐two cohort studies [1–3, 6, 11, 13, 15–18, 20, 22, 24, 25, 30–33, 37, 39, 40, 45, 50, 51, 55, 57, 64, 65, 67, 70, 71, 73, 75, 84, 88–90, 92, 96, 98, 99, 102] and three registries [4, 9, 72] reported revision rates of which 22 cohort studies were published between 1995 and 2009 [1, 6, 13, 15, 16, 18,…”

“…Forty‐two cohort studies [1–3, 6, 11, 13, 15–18, 20, 22, 24, 25, 30–33, 37, 39, 40, 45, 50, 51, 55, 57, 64, 65, 67, 70, 71, 73, 75, 84, 88–90, 92, 96, 98, 99, 102] and three registries [4, 9, 72] reported revision rates of which 22 cohort studies were published between 1995 and 2009 [1, 6, 13, 15, 16, 18, 24, 25, 32, 45, 50, 51, 55, 64, 65, 67, 73, 88–90, 92, 98] and 20 were published since 2010 [2, 3, 11, 17, 20, 22, 30, 31, 33,…”

Patellofemoral Arthroplasty

“…[37][38][39] Those who choose PFA tend to feel that it represents a good bridging option to an eventually needed TKA and additionally affords faster recovery times, bone preservation, maintenance of ligamentous proprioception, and the ability to delay TKA. [4][5][6] In a retrospective, matched cohort study, it was found that PFA resulted in markedly better range of motion, higher Knee Society Score, and higher mean Forgotten Joint Score at both 1 and 3 years postoperatively than patients who received TKA for isolated PFOA. 40 Finally, one study has looked at the economic effect of PFA versus TKA and found that PFA may be economically superior in younger patients with Markov modeling showing that while PFA was more expensive than TKA ($49,811 versus $46,632, respectively), it was more effective over a lifetime (14.3 quality-adjusted life year gains vs 13.3 QALYS).…”

“…Consistently, studies show that the most common reason for failure of PFA is progression of tibiofemoral OA with approximately 32% to 49% of revisions being done for this reason. 4-6,9,18-21,32,33 Other reasons for failure involve pain (16% to 17%), aseptic loosening (14%), patellar maltracking (6% to 10%), and infection (2% to 3%). 32,33 The two most common causes for PFA failure being progression of OA and pain highlight the importance of patient selection and indication for this procedure.…”

“…2,3 PFA offers several potential advantages in appropriately selected patients including improved function with faster recovery times, bone preservation, reduced blood loss, shorter surgical times, maintenance of ligamentous proprioception, and the ability to delay TKA. [4][5][6] Furthermore, recent studies have demonstrated cost-effectiveness when PFA is done in younger patients. 7,8 Enhancement in patient selection, surgical technique, implant design, and technology has led to improved short-term and midterm outcomes making PFA an attractive alternative to TKA.…”