Abstract

PurposeTo analyze whether preoperative patellofemoral anatomy is associated with clinical improvement and failure rate after isolated patellofemoral arthroplasty (PFA) using a modern inlay-type trochlear implant.MethodsProspectively collected 24 months data of patients treated with isolated inlay PFA (HemiCAP® Wave, Arthrosurface, Franklin, MA, USA) between 2009 and 2016, and available digitalized preoperative imaging (plain radiographs in three planes and MRI) were retrospectively analyzed. All patients were evaluated using the WOMAC score, Lysholm score, and VAS pain. Patients revised to TKA or not achieving the minimal clinically important difference (MCID) for the total WOMAC score or VAS pain were considered failures. Preoperative imaging was analyzed regarding the following aspects: Tibiofemoral OA, patellofemoral OA, trochlear dysplasia (Dejour classification), patellar height (Insall–Salvati index [ISI]; Patellotrochlear index [PTI]), and position of the tibial tuberosity (TT–TG and TT–PCL distance).ResultsA total of 41 patients (61% female) with a mean age of 48 ± 13 years could be included. Fifteen patients (37%) were considered failures, with 5 patients (12%) revised to TKA and 10 patients (24%) not achieving MCID for WOMAC total or VAS pain. Failures had a significantly higher ISI, and a significantly lower PTI. Furthermore, the proportion of patients with a pathologic ISI (> 1.2), a pathologic PTI (< 0.28), and without trochlear dysplasia were significantly higher in failures. Significantly greater improvements in clinical outcome scores were observed in patients with a higher preoperative grade of patellofemoral OA, ISI ≤ 1.2, PTI ≥ 0.28, TT–PCL distance ≤ 21 mm, and a dysplastic trochlea.ConclusionPreoperative patellofemoral anatomy is significantly associated with clinical improvement and failure rate after isolated inlay PFA. Less improvement and a higher failure rate must be expected in patients with patella alta (ISI > 1.2 and PTI < 0.28), absence of trochlear dysplasia, and a lateralized position of the tibial tuberosity (TT–PCL distance > 21 mm). Concomitant procedures such as tibial tuberosity transfer may, therefore, be considered in such patients.Level of evidenceLevel III, retrospective analysis of prospectively collected data.

Highlights

  • Patellofemoral arthroplasty (PFA) has become a valid treatment option for relatively young and active patients with isolated patellofemoral osteoarthritis (OA) [26, 42, 52]

  • The most important finding of the present study was that preoperative patellofemoral anatomy is significantly associated with clinical improvement and failure after isolated inlay PFA

  • Less improvement and higher failure rates were observed in patients with patella alta (ISI > 1.2 and Patellotrochlear index (PTI) < 0.28), absence of trochlear dysplasia, and a lateralized position of the tibial tuberosity (TT–PCL distance > 21 mm)

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Summary

Introduction

Patellofemoral arthroplasty (PFA) has become a valid treatment option for relatively young and active patients with isolated patellofemoral osteoarthritis (OA) [26, 42, 52]. Whereas implant design-specific complications were the main reasons for failure with early PFA designs, progression of tibiofemoral OA is considered the main failure mode of contemporary used implants [5, 51]. Another important reason leading to failure especially in the early postoperative course is unaddressed patellar maltracking [2, 17, 43, 51].

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