The Appropriate Use of Patellofemoral Arthroplasty

Leadbetter, Wayne B.; Ragland, Phillip S.; Mont, Michael A.

doi:10.1097/01.blo.0000172304.12533.41

Cited by 110 publications

(49 citation statements)

References 30 publications

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“…Table II outlines the relevant factors that, according to the literature, affect the outcome of PFA and potential ways to improve modifiable risk factors for a poor outcome. The classic indication for PFA is degenerative or posttraumatic arthritis confined to the patellofemoral joint causing severe pain and functional impairment that is not manageable by conservative measures 30-36 . Several authors have emphasized the importance of patient selection with the best patient outcomes being reported in a refined patient group 31,37 .…”

Section: Resultsmentioning

confidence: 99%

Modern Patellofemoral Arthroplasty

Bond,

Stauffer,

Hendren

et al. 2023

JBJS Reviews

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Introduction: The ideal procedure for isolated patellofemoral arthritis is a controversial topic. Patellofemoral arthroplasty (PFA) is an option that aims to restore normal kinematics to the knee while preserving bone. PFA has been shown to have benefits compared with total knee arthroplasty (TKA) in this patient population but has historically had a high failure rate. Revision rates are improving with modern implants and tight indications but still remain higher than TKA. This review summarizes current thinking around PFA using modern implants and techniques in 2023, provides an implant-specific analysis, and assesses how we can improve outcomes after PFA based on the current literature. The aim was to provide an outline of the evidence around PFA on which surgeons can make decisions to optimize patient outcome in this young and active population. Methods: Four databases (MEDLINE, Embase, Scopus, and SPORTDiscus) were searched for concepts of patellofemoral joint arthroplasty. After abstract and text review, a screening software was used to assess articles based on inclusion criteria for studies describing indications, outcomes, and techniques for isolated PFA using modern implants, with or without concomitant procedures. Results: A total of 191 articles were included for further examination, with 62 articles being instructional course lectures, systematic reviews, technique articles, narrative reviews, expert opinions, or meta-analyses. The remaining articles were case reports, trials, or cohort studies. Articles were used to create a thorough outline of multiple recurrent topics in the literature. Conclusions: PFA is an appealing option that has the potential to provide a more natural feeling and functioning knee for those with isolated PF arthritis. The high rate of revision is a cause for concern and there are several technical details that should be stressed to optimize results. The uncertain outcome after revision to TKA also requires more investigation. In addition, the importance of strict selection criteria and firm indications cannot be stressed enough to optimize longevity and attempt to predict those who are likely to have progression of tibiofemoral osteoarthritis. The development of new third-generation implants is promising with excellent functional outcomes and a much lower rate of maltracking and implant complications compared with earlier generations. The impact of these implants and improvement in surgical techniques on the revision rate of PFA will be determined from longer-term outcomes.

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Section: Resultsmentioning

confidence: 99%

Modern Patellofemoral Arthroplasty

Bond,

Stauffer,

Hendren

et al. 2023

JBJS Reviews

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“…In 2004 Merchant reported the early clinical results of the Low Contact Stress Patellofemoral Joint and reported good clinical outcome in 14 of 15 patients using the ADL scale [8]. However, the need for a mobile-bearing patellar component is debatable, as loosening and wear are not major reasons for revision of a patellofemoral arthroplasty [2,6]. Wear of the patellar polyethylene is although frequently seen in cases of revision for other reasons.…”

Section: Resultsmentioning

confidence: 99%

“…Patellofemoral arthroplasty is a successful treatment alternative for isolated patellofemoral osteoarthritis. Good results may be expected with appropriate use and consideration of reported indications and contraindications [2]. Long-term outcome is related to the progression or development of femorotibial osteoarthritis, malposition of the prosthesis, and, to a lesser extent, wear and/or loosening of the patellar component.…”

Section: Introductionmentioning

confidence: 99%

Dissociation of mobile-bearing patellar component in low contact stress patellofemoral arthroplasty, its mechanism and management: two case reports

2009

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IntroductionIsolated patellofemoral osteoarthritis can be treated with patellofemoral arthroplasty.Case presentationWe present two cases of isolated patellofemoral osteoarthritis treated with Low Contact Stress patellofemoral arthroplasty; in both cases the polyethylene mobile-bearing of the patellar component dissociated from the metal backing. One patient had a revision to a Richards patellofemoral prosthesis, and in the second patient the arthroplasty was converted to a total knee prosthesis because of clinically important femorotibial osteoarthritis.ConclusionThe possible failure mechanisms are described. We suggest avoiding the use of a metal-backed mobile-bearing patellar component due to the risk of dissociation.

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“…Leadbetter recommended criteria should include varus deformity <5°, valgus deformity< 8°, free flexion of 120° and flexion contracture<10°. 24 As for radiographic assessment, we suggest at least incorporating plain radiographs including the weight-bearing anteroposterior view, lateral view, and patellar axial view as we used for pre-operative assessment. Considering the over-sensitivity of MRI in evaluating OA, pre-operative MRI results are not recommended for determining candidacy for unicompartmental knee arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Long-Term clinical results of patellofemoral arthroplasty for isolated patellofemoral osteoarthritis

Wang

Bian

Qian

2023

J Orthop Surg (Hong Kong)

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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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The Appropriate Use of Patellofemoral Arthroplasty

Cited by 110 publications

References 30 publications

Modern Patellofemoral Arthroplasty

Modern Patellofemoral Arthroplasty

Dissociation of mobile-bearing patellar component in low contact stress patellofemoral arthroplasty, its mechanism and management: two case reports

Long-Term clinical results of patellofemoral arthroplasty for isolated patellofemoral osteoarthritis

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