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

Abstract

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

The compartmental approach to revision of partial knee arthroplasty results in nearer-normal gait and improved patient reported outcomes compared to total knee arthroplasty

“…Native compartment disease progression remains one of the most common reasons for revision of primary PKA, though the incidence varies between studies [ 10 , 31 , 33 , 37 ]. In one series, of PFA revised to TKA, 56% resulted from disease progression in the tibiofemoral compartments [ 27 ], while in another, 76% of UKA were revised for the same reason [ 22 ]. However, the 20 year series from collected by Svard, reported just 2.3% revision rate for lateral compartment progression following UKA-M in the designer centre [ 36 ].…”

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

“…The main cause of revision in our study was the progression of tibiofemoral OA, which is consistent with the findings of a recent systematic review 22 and registry data. 23 In addition, of the 14 unreplaced PFAs, 6 cases of radiographic tibiofemoral OA were found. The failure mode demonstrated not only implant durability but also the importance of patient selection.…”

Patellar button compatibility in the conversion of Patellofemoral Arthroplasty to a Total Knee Arthroplasty: A review of the contemporary literature

“…Overall, although there was a trend for a higher complication rate for revision PFA in comparison to primary TKA, in each of the studies where the original patellar button was left in situ, no complications related to the extensor mechanism at follow-up after conversion were described. 7,9,15 Looking at Australian Orthopaedic Association Joint Replacement Registry (ANJRR) data reviewing the risk of repeat revision when PFA was revised to a TKA over a 17year period, Lewis et al (2019) 16 found that the main reasons for revision were progression of OA (56%), component loosening (17%) and refractory pain (12%). Of all PFA revisions, 42% had the index patellar component revised -however, there was no subsequent difference in rates of secondary revision when considering initial retention versus revision.…”

“…Looking at Australian Orthopaedic Association Joint Replacement Registry (ANJRR) data reviewing the risk of repeat revision when PFA was revised to a TKA over a 17-year period, Lewis et al (2019) 16 found that the main reasons for revision were progression of OA (56%), component loosening (17%) and refractory pain (12%). Of all PFA revisions, 42% had the index patellar component revised - however, there was no subsequent difference in rates of secondary revision when considering initial retention versus revision.…”