The Avon patellofemoral arthroplasty

Abstract

We report the mid-term results of a new patellofemoral arthroplasty for established isolated patellofemoral arthritis. We have reviewed the experience of 109 consecutive patellofemoral resurfacing arthroplasties in 85 patients who were followed up for at least five years. The five-year survival rate, with revision as the endpoint, was 95.8% (95% confidence interval 91.8% to 99.8%). There were no cases of loosening of the prosthesis. At five years the median Bristol pain score improved from 15 of 40 points (interquartile range 5 to 20) pre-operatively, to 35 (interquartile range 20 to 40), the median Melbourne score from 10 of 30 points (interquartile range 6 to 15) to 25 (interquartile range 20 to 29), and the median Oxford score from 18 of 48 points (interquartile range 13 to 24) to 39 (interquartile range 24 to 45). Successful results, judged on a Bristol pain score of at least 20 at five years, occurred in 80% (66) of knees. The main complication was radiological progression of arthritis, which occurred in 25 patients (28%) and emphasises the importance of the careful selection of patients. These results give increased confidence in the use of patellofemoral arthroplasty.

(vi) Focal resurfacing implants in the knee and partial knee replacements

“…The designing surgeons have reported five-year MINI-SYMPOSIUM: SOFT TISSUE KNEE e CURRENT CONCEPTS ORTHOPAEDICS AND TRAUMA 29:1 survival of 95.8%, with improvement in the Oxford knee score from 18 out of 48 pre-operatively to 39 post-operatively. 29 These results have also been replicated by other independent centres. 30 The NJR, however, reports a survivorship of only 87.47% at 8 years.…”

Isolated patellofemoral osteoarthritis

“…Operative treatment: Arthroscopy: 2 randomized controlled trials (165 and 168 patients) were included based on indirect evidence (Moseley et al 2002, Kirkley et al 2008)Chondroplasty, resection-arthroplasty, and lateral facetectomy: 1 prospective case series (50 patients) (Becker et al 2008) and 4 retrospective case series (11–63 patients) (Beltran 1987, Yercan et al 2005, Spak and Teitge 2006, Paulos et al 2008)Extensor mechanism alignment and lateral release: 2 prospective case series (35 and 50 patients) (Alemdaroglu et al 2008, Becker et al 2008), 2 retrospective comparative studies (12 and 48 patients) (Weaver et al 1991, Jacquot et al 2004), and 3 retrospective case series (14–50 patients) (Aderinto and Cobb 2002, Kohn et al 2004, Carofino and Fulkerson 2008)Patellectomy: no studies met the inclusion criteriaTotal knee arthroplasty: 2 matched case-control studies (94 and 54 patients) of total knee arthroplasty for isolated patellofemoral osteoarthritis compared with total knee arthroplasty for tri-compartmental osteoarthritis (Laskin and Van Steijn 1999, Meding et al 2007), 1 prospective case series (24 patients) (Parvizi et al 2001), and 3 retrospective case series (25–47 patients) (Mont et al 2002, Dejour et al 2004, Dalury 2005)Patellofemoral arthroplasty: 3 systematic reviews of case series (538–812 patients) (Leadbetter et al 2005, 2006, Becher et al 2008), 5 prospective case series (15–240 patients) (Arnbjornsson and Ryd 1998, Tauro et al 2001, Merchant 2004, Ackroyd and Chir 2005, Ackroyd et al 2007), and 16 retrospective case series (12–65 patients) (Arciero and Toomey 1988, Cartier et al 1990, Argenson et al 1995, Krajca-Radcliffe and Coker 1996, Mertl et al 1997, De Cloedt et al 1999, Fink et al 1999, de Winter et al 2001, Smith et al 2002, Kooijman et al 2003, Board et al 2004, Argenson et al 2005, Cartier et al 2005, Merchant 2005, Sisto and Sarin 2006, Gadeyne et al 2008). …”

“…Patellofemoral arthroplasty: 3 systematic reviews of case series (538–812 patients) (Leadbetter et al 2005, 2006, Becher et al 2008), 5 prospective case series (15–240 patients) (Arnbjornsson and Ryd 1998, Tauro et al 2001, Merchant 2004, Ackroyd and Chir 2005, Ackroyd et al 2007), and 16 retrospective case series (12–65 patients) (Arciero and Toomey 1988, Cartier et al 1990, Argenson et al 1995, Krajca-Radcliffe and Coker 1996, Mertl et al 1997, De Cloedt et al 1999, Fink et al 1999, de Winter et al 2001, Smith et al 2002, Kooijman et al 2003, Board et al 2004, Argenson et al 2005, Cartier et al 2005, Merchant 2005, Sisto and Sarin 2006, Gadeyne et al 2008). …”

Patellofemoral arthroplasty, where are we today?

“…Ackroyd et al [2] noted progression of tibiofemoral osteoarthritis to be the primary late complication in a series of 306 Avon prostheses. They noted that this complication was not predicted by the functional results or pain control achieved by the prosthesis in the first 2 years following surgery.…”