Patellofemoral Arthroplasty Research Articles

SURVIVORSHIP AND FUNCTIONAL OUTCOMES OF FEMORO PATELLA VIALLI PATELLOFEMORAL JOINT REPLACEMENTS

AbstractIntroductionIsolated patellofemoral joint(PFJ) osteoarthritis affects approximately 10% of patients aged over 40 years and treatment remains controversial. Our aim was to evaluate long term functional and radiological outcomes following PFJ arthorplasty with the Femoro Patella Vialli (FPV) prosthesis as this evidence is lacking in literature.MethodologyA retrospective review of prospectively collected PROMS in patients undergoing Patellofemoral arthroplasty. Single centre trial. Between 2004 and 2008, 101 FPV patellofemoral arthroplasties were performed in 80 patients with isolated patellofemoral joint osteoarthritis. Data was collected as a part of routine follow-up for up to 6 years and additional long term data was collected at 16 years.ResultsAt 6 year follow up the mean OKS was 29 and by 16 year follow up it was 26 which was not a statistically significant drop. 22 patients (29 knees) had died, 32 (32%) had been revised, 25 to total knee replacement using primary arthroplasty components. Mean OKS in the revised group was 27 which was not a statistically significant difference when compared to the unrevised group. Mean time to revision was 4 years. The cumulative survival analysis of the FPV implant was 76% at 5 years, 64% at 10 years.ConclusionOur findings suggest the FPV patellofemoral prosthesis provides good pain relief and clinical outcomes however, the survivorship for this particular implant maybe lower as compared to the available literature. Patient reported outcomes are maintained over the implant life and are no worse once revised implying a staged approach to arthroplasty is reasonable.

Poster 300: A Novel Magnetic Resonance Imaging (MRI) Scoring System to Evaluate Patellofemoral Osteoarthritis

Objectives: Knee osteoarthritis (OA) is a common degenerative or post-traumatic condition, and may affect one or more compartments, including the medial and lateral tibiofemoral or patellofemoral articulations. Isolated patellofemoral osteoarthritis (PFOA) has been reported in 24% of women and 11% of men aged > 55 years presenting for evaluation of knee pain. PFOA is a result of abnormal mechanical loading across the patellofemoral joint, often related to prior instability, trauma, malalignment or post- surgical changes. Treatment of PFOA typically includes a trial of conservative management, including physical therapy, injections and activity modification. Operative treatment involves joint preservation (i.e., cartilage restoration procedures, tibial tubercle osteotomy, or lateral lengthening) and joint replacement (patellofemoral arthroplasty) procedures. In contrast to the tibiofemoral compartments, the current literature lacks a reliable magnetic resonance imaging (MRI) scoring system to quantitatively evaluate patellofemoral cartilage degeneration. The present study aims to describe, apply and assess the inter-observer reliability of a novel MRI scoring system for assessment of the patellofemoral cartilage. Methods: We conducted a query of an institutional database to identify all patients who underwent patellofemoral arthroplasty by the senior surgeon (S.M.S.) between January 2012 and December 2021. Patients with poor quality or lacking preoperative knee MRI were excluded. MRI scans were performed on 1.5 or 3.0-Tesla magnets utilizing dedicated extremity coils and standardized clinical imaging protocols consistent with International Cartilage Regeneration and Joint Preservation Society (ICRS) guidelines for the assessment of articular cartilage. Preoperative MRI scans were reviewed and patellofemoral cartilage was scored by a fellowship-trained musculoskeletal radiologist and a fellowship- trained orthopedic knee surgeon using our novel MRI scoring system. The novel semi-quantitative MRI patellofemoral scoring system includes assessment of patellar and trochlear cartilage, bony architecture, patellofemoral alignment, and synovitis (Table 1). For statistical analysis, inter-observer agreement was assessed using Cohen-Kappa coefficient for categorical variables, and intraclass correlation coefficient (ICC) for the total score. The measurement agreement for reach variable and total score was interpreted according to the Landis and Koch criteria: 0 - 0.2, slight; 0.21 - 0.4, fair; 0.41 - 0.6, moderate; 0.61 - 0.80, substantial; 0.81 - 1.0, almost perfect. Results: A total of 72 patients were included in the final analysis. The mean (± standard deviation) age and body mass index (BMI) of all patients was 53.30±7.72 years and 27.3±5.37 kg/m, respectively. Patellar bone edema and patellar cysts demonstrated moderate inter-observer agreement. All cartilage features, trochlear bone edema and cysts, osteophytes, subchondral remodeling, patellar height, and synovitis demonstrated substantial inter-observer agreement. Patellofemoral alignment and total score demonstrated almost perfect inter-observer agreement (Table 2 and Figure 1). Conclusions: The novel MRI scoring system for PFOA proposed by the authors is an attempt to develop a comprehensive method to assess patellofemoral joint cartilage degeneration, including evaluation of patellar and trochlear cartilage changes, bony architecture, patellofemoral alignment, and synovitis. Importantly, all features of the scoring system demonstrated at least moderate inter-observer agreement, with the majority of variables and total score demonstrating substantial to near perfect agreement. Future studies should aim to validate this scoring system in patients with and without patellofemoral arthritis and attempt to correlate scores with clinical outcomes. [Table: see text][Table: see text]

Patellofemoral Arthroplasty.

Patellofemoral arthroplasty (PFA) as a treatment option for isolated patellofemoral disease continues to evolve. Enhancement in patient selection, surgical technique, implant design, and technology has led to improved short-term and midterm outcomes. Furthermore, in the setting of a younger patient with isolated patellofemoral arthritis, PFA represents an option for improved function with faster recovery times, bone preservation, maintenance of ligamentous proprioception, and the ability to delay total knee arthroplasty (TKA). The most common reason for revising PFA to a TKA is progression of tibiofemoral arthritis. In general, conversion of PFA to TKA leads to successful outcomes with minimal bone loss and the ability to use primary TKA implants and instrumentation. PFA seems to be a cost-effective alternative to TKA in appropriately selected patients with 5-, 10-PFA survivorships of 91.7% and 83.3%, respectively, and an annual revision rate of 2.18%; however, more long-term clinical studies are needed to determine how new designs and technologies affect patient outcomes and implant performance.

Short-Term Outcomes of Concomitant Patellofemoral Arthroplasty and Medial Patellofemoral Ligament Reconstruction to Treat Concurrent Patellofemoral Arthritis and Patellar Instability.

The purpose of this study was to evaluate the efficacy of combined patellofemoral arthroplasty (PFA) and medial patellofemoral ligament (MPFL) reconstruction in patients with patellofemoral arthritis in the setting of concomitant patellar instability. Patients who underwent single-stage, combined PFA and MPFL reconstruction by a single surgeon at a tertiary-care orthopaedic center between 2016 and 2021 were identified. Postoperative radiographic and clinical outcomes at a minimum of 6 months were recorded using patient-reported outcome measures, including International Knee Documentation Committee (IKDC), Kujala, and VR-12. Early complications and rates of recurrent instability were also recorded. Of the 16 patients who met inclusion and exclusion criteria, 13 patients were available for final follow-up (81%; 51.7 ± 7.2 years, 11 females, 2 males) with a mean clinical follow-up of 1.3 ± 0.5 years (range: 0.5-2.3 years). Patients experienced significant improvements in patellar tilt and multiple patient-reported outcome metrics postoperatively, including IKDC, Kujala, VR-12 Mental Health, and VR-12 Physical Health. At the time of the most recent follow-up, no patient had experienced a postoperative dislocation or subluxation event. The findings suggest that concurrent PFA and MPFL reconstruction are associated with significant improvements in multiple patient-reported outcomes. Further studies are needed to evaluate the duration of clinical benefits achieved with this combined intervention.

Erratum to: Patellofemoral Arthroplasty Results in Better Time-weighted Patient-reported Outcomes After 6 Years than TKA: A Randomized Controlled Trial.

Odgaard, Anders MD, DMSc, FRCS1; Kappel, Andreas MD, PhD2; Madsen, Frank MD3; Kristensen, Per Wagner MD4; Stephensen, Snorre MD5; Attarzadeh, Amir Pasha MD6 Author Information

Internal Rotation, Varus, and Anterior Femoral Component Malalignments Adversely Affect Patellofemoral Joint Kinematics in Patellofemoral Arthroplasty.

Patellofemoral arthroplasty (PFA) is reported to provide nearly normal PF joint kinematics but only with adequate surgical techniques. This study evaluated the effects of various femoral component settings on patellar component biomechanics. A dynamic musculoskeletal computer simulation analyzed normal knee and standard PFA models, as well as 8 femoral component malposition models: 5° internal or external rotation, 5° valgus or varus, 5° extension or flexion, and 3-mm or 5-mm anterior positioning. Mediolateral patellar translation, lateral patellar tilt, and contact force and stress at the PF joint were measured in each model during gait. The patella in the standard PFA model was shifted up to 5.0 mm laterally near heel off and was tilted up to 3.0° laterally at heel strike compared to the normal knee model. The patella in the external rotation model translated more laterally in the direction of the femoral component setting than in the standard model. However, in the internal rotation and varus alignment models, the patellar lateral shift occurred largely in the opposite direction of the femoral component setting. The patella in most models was tilted in the same direction as the femoral component setting. The PF contact force was increased, especially in the anterior femoral position models, by up to 30 MPa compared with 20 MPa in the standard model. Internal rotation, varus, and anterior femoral component settings during PFA should be avoided to reduce postoperative complications, whereas external rotation might be appropriate only for cases with lateral patellar instability.

Patellofemoral arthroplasty conversion to total knee arthroplasty: An updated retrieval analysis and clinical outcomes

BackgroundA prior retrieval analysis found high rates of infection after conversion of PFA to TKA, but was limited by a small sample size. The purpose of this study is to perform a retrieval analysis with clinical correlation on an expanded group of patients to better understand conversion of PFA to TKA. MethodA retrospective review of an implant retrieval registry identified 62 conversions of PFA to TKA between 2004–2021. Implants were analyzed for wear pattern and cement fixation. Patient charts were reviewed for demographic information, perioperative data, prior and subsequent surgical procedures, complications and outcomes. Radiographs performed prior to index PFA and conversion procedures were assessed for KL grading. ResultsCement fixation was present on 86% of retrieved components and wear was more pronounced on the lateral side. The most common indication for conversion to TKA was progression of OA in 46.8% of patients, followed by unexplained pain in the absence of radiographic or clinical changes (37.1%), loosening (8.1%), mechanical symptoms (4.8%), traumatic (3.2%). Thirteen patient experienced complications requiring additional procedures including arthrofibrosis (n = 4, 7.3%), PJI (n = 3, 5.5%), instability (n = 3, 5.5%), hematoma (n = 2, 3.6%) and loosening (n = 1, 1.8%). Revision components were used in 1.8% of cases and average post-conversion arc of motion was 119 degrees. ConclusionsThe most common reason for PFA conversion to TKA was progression of osteoarthritis. PFA conversion to TKA is technically similar to primary TKA, but complication rates are more consistent with revision TKA in this study.

Patellofemoral Arthroplasty Is an Efficient Strategy for Isolated Patellofemoral Osteoarthritis with or without Robotic-Assisted System.

There is relative paucity in the literature concerning outcomes after robotic-assisted Patellofemoral Arthroplasty (PFA). The aims were (1) to evaluate outcomes in patients undergoing PFA with inlay or onlay components, with or without robotic arm assistance and (2) to identify risk factors of poor outcomes after PFA. This retrospective study included 77 PFA for isolated patellofemoral joint osteoarthritis, assigned to three groups (18 conventional technique, 17 image-free robotic-assisted system and 42 image-based robotic-assisted system). The demographic data were comparable between the three groups. The clinical outcomes assessed were: Visual Analogue Scale, Knee Society Score, Kujala score and satisfaction rate. The radiological measures were: Caton Deschamps index, patellar tilt and frontal alignment of the trochlea. Functional outcomes, satisfaction rate and residual pain were comparable between the three groups. Patellar tilt improvement was superior when a robotic device was used (either image-based or image-free) compared to the conventional technique. There were three revisions (3.9%) at the last follow-up related to femorotibial osteoarthritis progression. Multivariate analysis found no significant risk factors for poor outcomes, with respect to the surgical technique or implant design. Functional outcomes and revisions rate after PFA were comparable between the surgical techniques and implants. Robotic-assisted systems were associated with a superior improvement of the patellar tilt compared to the conventional technique.

Outcomes are Compromised When Revising Patellofemoral Arthroplasties for Patellar Component Failures

BackgroundOutcomes of patellofemoral arthroplasty (PFA) to total knee arthroplasty (TKA) conversion are reported to be similar to primary cases. The purpose of this study was to determine whether the cause for conversion from PFA to TKA correlated to outcomes when compared to a matched cohort. MethodsA retrospective chart review was performed to identify aseptic PFA to TKA conversions between 2000 and 2021. A cohort of primary TKAs was matched by patient sex, body mass index, and American Society of Anesthesiology score. Clinical outcomes, including range of motion, complication rates, and patient reported outcomes measurement information systems scores, were compared. Chi-squared, Fisher’s Exact, and t-tests were performed. There were 20 PFA to TKA conversions that met inclusion criteria and were matched to 60 primary cases. ResultsThere were 7 cases revised for arthritis progression, 5 for femoral component failure, 5 for patellar component failure, and 3 for patellar maltracking. PFA to TKA conversions for patellar failure (fracture, component loosening) had worse postoperative flexion (115 versus 127°, P = .023) and more complications of stiffness (40 versus 0%, P = .046) than primary TKAs. Conversions for failed patellar components had worse patient reported outcomes measurement information systems physical function (32 versus 45, P = .0046), physical health (42 versus 49, P = .0258), and pain scores (45 versus 24, P = .0465). No differences were found in rates of infection, manipulations under anesthesia, or reoperations. ConclusionPFA to TKA conversion outcomes were similar to primary TKA, except in patients who had failed patellar components and demonstrated worse postoperative range of motion and patient-reported outcomes. Surgeons should avoid thin patellar resections and extensive lateral releases to minimize patellar failures.

Artículo traducido] Resultados a medio plazo de la artroplastia femoropatelar

BackgroundThe purpose of this study is the evaluation of the patellofemoral arthroplasty (PFA) survival and clinical and radiological outcomes in our institution. MethodsA retrospective evaluation of our institution patellofemoral arthroplasty cases from 2006 to 2018 was performed; the n sample after applying exclusion and inclusion criteria was 21. All patients excepting one were female with a median age of 63 (20-78). A Kaplan-Meier survival analysis at ten years was calculated. Informed consent was obtained from all patients prior being included in the study. ResultsThe total revision rate was 6 out of 21 patients (28.57%). The progression of the osteoarthritis in the tibiofemoral compartment was the main cause (50% of revision surgeries). The degree of satisfaction with the PFA was high, with a mean Kujala score of 70.09 and a mean OKS of 35.45 points. The VAS score improved significantly (P<.001) from a preoperative mean of 8.07 to a postoperative mean of 3.45, with an average improvement of 5 (2-8). Survival at 10 years, with revision for any reason as the endpoint, was 73.5%. A significant positive correlation between BMI and the WOMAC pain (r=.72, P<.01) and between BMI and the post-operative VAS (r=.67, P<.01) was observed. ConclusionsThe results of the case series under consideration suggest that PFA could be a possibility in the joint preservation surgery on the isolated patellofemoral osteoarthritis. BMI >30 seems to be a negative predictor factor in relationship with the postoperative satisfaction, increasing the pain proportionally to this index and requiring more replacement surgery than patients with BMI <30. Meanwhile the radiologic parameters of the implant are not correlated with the clinical or functional outcomes.

Outcomes of Patellar Replacement Vs Patellar Neurectomy in Total Knee Replacement

Objectives: To compare the outcomes of patellar replacement and patellar neurectomy in Patients undergoing Total Knee Replacement . Materials &amp; Methods: The design of this study was a cross sectional study design and this study was conducted in DHQ Teaching Hospital Gujranwala. Total 30 Patients were enrolled in this study and they were divided into two groups. Group A constitutes of 15 Patients underwent Post tibial neurectomy. And Group B consisting of 15 Patients went through Tibial Resection. All the patients have been assessed through the Tinel test on the painful area and self-administered Patient-Reported Outcome Measurements (PROMs): Patellar replacement also known as patellofemoral arthroplasty, is a surgical procedure that is performed in conjunction with total knee replacement (TKR) to relieve pain in the knee joint caused by patellofemoral arthritis or other conditions affecting the patella. All the patients of Group B were given anesthesia to numb the area. An incision was made in front of the knee to expose the patella and surrounding structures. Removal of the patella: The patella was carefully removed from the knee joint. The underside of the patella was reshaped to fit a prosthetic component that was implanted in its place. The patellar component was attached to the reshaped surface of the patella using bone cement. The patella was repositioned in the knee joint and attached to the femur using sutures. The incision was closed using sutures or staples. The goal of patellar replacement is to reduce pain and improve function in the knee joint. All the group A participants went through Patellar neurectomy. Patellar neurectomy is a surgical procedure that involves cutting or removing the nerve endings that supply sensation to the patella. Results: Total 30 Patients participated in this study. In Group A =15 Patients who underwent patellar Neurectomy and 15 Patients in Group B who experienced Tibia Resection. Total 5 months follow up was done. Group B participants showed excellent Results. NRS score decreased to 0 in Group B. While in patellar Neurectomy group A two patients experienced still moderate pain, Remaining 13 patients although did not experienced pain but felt numbness on limbs. Practical Implication: Patellar neurectomy involves cutting or removing the nerve endings that supply sensation to the patella, interrupting the transmission of pain signals from the patella to the brain. Although it is less time consuming but can cause numbness or altered sensation in the skin over the patella, which may affect the patient's quality of life Does not address underlying patellar instability or misalignment, which can still cause pain and functional limitations Can be associated with a risk of complications such as neuroma, infection, stiffness. Conclusion: Patellar Resection with TKA has better outcomes than Patellar Neurectomy. Patellar denervation with electrocautery is effective in reducing pain and opioid consumption after total knee replacement. Postoperative range of motion is significantly better in patellar denervation group, which means that patellar denervation significantly improves clinical outcome Keywords: Total Knee Replacement, Patellar Replacement, Neurectomy, Neurectomy, Tibia Resection, Pain, Prosthesis

Occupational and Functional Outcomes following Patellofemoral Arthroplasty in U.S. Military Servicemembers.

The functional outcomes in patients undergoing patellofemoral arthroplasty (PFA) with high occupational demands have not been fully examined. This study assessed return to work and conversion to TKA rates following PFA in a young, military cohort. Patient demographics, pain scores, and surgical information were retrospectively collected for all active-duty military members who underwent PFA over a 4-year period. The data were then analyzed to calculate return to work, conversion to TKA, and perioperative complications rates. A total of 48 servicemembers with 60 total PFAs (36 unilateral, 12 bilateral) were included, with a mean follow up of 2.2 years. At the final follow-up, 83% of servicemembers returned to military service or completed their service obligation after PFA. Conversion to TKA occurred in three (6.2%) patients at an average of 2.4 years after PFA, resulting in a PFA annual revision rate of 2.3%. The mean numeric rating scale for pain improved from 4.9 ± 2.6 at baseline to 2.5 ± 2.0 postoperatively (p < 0.001). Servicemembers with at least one prior ipsilateral knee procedure had a significantly decreased odds ratio (OR) for both occupational outcome failure (OR, 0.03; 95% confidence interval [CI], 0-0.29) and overall failure (OR, 0.13; 95% CI, 0.02-0.78). At an average of 2 years following PFA, 83% of military members returned to duty, with a low rate of revision to TKA. Prior ipsilateral knee procedure decreased the probability of medical separation. LEVEL OF EVIDENCE: IV.

Complications and costs of patellofemoral arthroplasty versus total knee arthroplasty

BackgroundPatellofemoral arthroplasty (PFA) is an alternative to total knee arthroplasty (TKA) for the treatment of patellofemoral arthritis. Although PFA may preserve native kinematics and accelerate recovery, it has been associated with higher revision rates. The purpose of this study is to compare complication rates and costs between PFA and TKA. MethodsUsing the PearlDiver database, 6,179 patients with isolated patellofemoral arthritis treated with PFA or TKA from 2010-2015 were retrospectively reviewed with 5-year follow up. PFA and TKA patients were matched by age, sex, and Elixhauser Comorbidity Index via a 1:1 stepwise algorithm. Five-year costs and complications were compared between matched cohorts. The lifetime costs of PFA and TKA were evaluated with Markov decision modeling. ResultsCompared to TKA, PFA was associated with fewer Emergency Department (ED) visits (6.1% vs 3.9%, p = 0.004) but a higher 5-year revision rate (9.9% vs 4.2%, p < 0.001). After multivariate regression, PFA was independently more likely to require revision (odds ratio 2.60, 95% confidence interval 1.32–4.71, p = 0.003). PFA was associated with lower total healthcare costs at every time point between 3 months ($18,014 vs $26,473, p < 0.001) and 5 years ($20,837 vs $27,942, p < 0.001). On average, the lifetime cost of PFA per patient was $5,235 less than for TKA ($26,343 vs $31,578). ConclusionsPFA is a less expensive alternative to TKA with a similar risk of medical complications but is associated with a significantly higher 5-year revision rate. Future studies should examine the reasons for PFA failure and methods to mitigate this risk.

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

The aim of this study was to explore the clinical outcomes and long-term survival of patellofemoral arthroplasty in treatment of isolated patellofemoral osteoarthritis. 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 18.9-29.6years. Knee Society Score (KSS), Oxford Knee Score (OKS), and University of California Los Angeles activity scale (UCLA) were used to assess functional outcomes. The implant survivorship was 83.6% at 15years, 76.8% at 20 years, and 59.4% at 25years 14 PFAs in 12 patients were revised into total knee arthroplasty at 16.0 ± 6.7years; 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). Type Y-L-Q patellofemoral arthroplasty can be an effective method for treating isolated patellofemoral osteoarthritis with satisfactory survival.

Midterm outcomes of patellofemoral arthroplasty

BackgroundThe purpose of this study is the evaluation of the patellofemoral arthroplasty (PFA) survival and clinical and radiological outcomes in our institution. MethodsA retrospective evaluation of our institution patellofemoral arthroplasty cases from 2006 to 2018 was performed; the n sample after applying exclusion and inclusion criteria was 21. All patients excepting one were female with a median age of 63 (20–78). A Kaplan–Meier survival analysis at ten years was calculated. Informed consent was obtained from all patients prior being included in the study. ResultsThe total revision rate was 6 out of 21 patients (28.57%). The progression of the osteoarthritis in the tibiofemoral compartment was the main cause (50% of revision surgeries). The degree of satisfaction with the PFA was high, with a mean Kujala score of 70.09 and a mean OKS of 35.45 points. The VAS score improved significantly (p<0.001) from a preoperative mean of 8.07 to a postoperative mean of 3.45, with an average improvement of 5 (2–8). Survival at 10 years, with revision for any reason as the endpoint, was 73.5%. A significant positive correlation between BMI and the WOMAC pain (r=0.72, p<0.01) and between BMI and the post-operative VAS (r=0.67, p<0.01) was observed. ConclusionsThe results of the case series under consideration suggest that PFA could be a possibility in the joint preservation surgery on the isolated patellofemoral osteoarthritis. BMI >30 seems to be a negative predictor factor in relationship with the postoperative satisfaction, increasing the pain proportionally to this index and requiring more replacement surgery than patients with BMI <30. Meanwhile the radiologic parameters of the implant are not correlated with the clinical or functional outcomes.

Expression of Concern: Patellofemoral Arthroplasty Results in Better Time-weighted Patient-reported Outcomes After 6 Years Than TKA: A Randomized Controlled Trial.

CORR Editorial Office, 300 S. Northwest Highway, Suite 203, Park Ridge, IL 60068, USA, Email: [email protected] Expression of Concern to: Clin Orthop Relat Res, DOI: 10.1097/CORR.0000000000002178. The online version of this article can be found under DOI: 10.1097/CORR.0000000000002178.

Reduced Early Revision Surgery and Medical Complications in Computer-assisted Knee Arthroplasty Compared With Non-computer-assisted Arthroplasty.

Computer assistance can help surgeons achieve mechanical accurate alignment, but the clinical effect of this technology in different arthroplasty types remains controversial because of conflicting functional outcomes, revision rates, and complication rates. The goal of this study was to compare 90-day medical complications and 1 and 2-year revision surgeries after computer-assisted patellofemoral arthroplasty, unicompartmental knee arthroplasty (CA-UKA), bicompartmental knee arthroplasty (CA-BKA), and total knee arthroplasty (CA-TKA) with non-computer-assisted procedures. A retrospective cohort analysis was conducted using the Mariner data set of the PearlDiver Patient Records Database from 2010 to 2018. Current Procedural Terminology codes were used to identify patients who underwent patellofemoral arthroplasty, unicompartmental knee arthroplasty, bicompartmental knee arthroplasty, and total knee arthroplasty with or without computer assistance for osteoarthritis. All included patients were followed up for 2 years. Univariate and multivariable analyses were conducted. On multivariable analysis, revision within 1 year was decreased in patients who underwent computer-assisted patellofemoral arthroplasty (odds ratio [OR]: 0.541, P = 0.031), CA-UKA (OR: 0.798, P = 0.019), and computer-assisted bicompartmental knee arthroplasty (OR: 0.186, P = 0.025) compared with the same surgeries without technology assistance. CA-TKA had decreased odds of revision for aseptic loosening at 2 years (OR: 0.789, P < 0.001). CA-UKA and CA-TKA had decreased risk of overall 90-day medical complications (OR: 0.838, P < 0.001; OR: 0.903, P < 0.001, respectively) and major complications (OR: 0.750, P = 0.004; OR: 0.822, P < 0.001, respectively). Complication rates and revision surgeries for all arthroplasty types were equivalent or more favorable when computer assistance was used during surgery. Our results quantify some early benefits to using computer assistance in total and partial knee arthroplasties.

Knee

The December 2022 Knee Roundup360 looks at: Effect of physical therapy versus arthroscopic partial meniscectomy: the ESCAPE trial at five years; Patellofemoral arthroplasty or total knee arthroplasty: a randomized controlled trial; Rehabilitation versus surgical reconstruction for anterior cruciate ligament injury; End-stage knee osteoarthritis in Australia: the effect of obesity; Do poor patient-reported outcome measures at six months relate to knee revision?; What is the cost of nonoperative interventions for knee osteoarthritis?

Patellofemoral Arthroplasty: Early Demographic and Radiological Analysis for Less Complications and Better Results

Patellofemoral Arthroplasty: Early Demographic and Radiological Analysis for Less Complications and Better Results

Functional Outcomes, Survival Rate, and Complications of Patellofemoral Arthroplasty: Mid-Term Results From Independent Center.

Background Patellofemoral arthroplasty (PFA) is indicated for isolated patellofemoral arthritis. PFA is a less invasive, bone-preserving procedure with faster recovery when compared to total knee replacement. We aim to present the functional outcome, survival rate, and complications of PFA from our center. Methods A total of 45 consecutive PFA performed (mean age 58.02 ± 9.2 years; 34 females and 11 males; Avon prosthesis) during the study period was included. Prosthesis survivorship was measured using revision as the endpoint, and functional outcome was assessed using Oxford knee scores (OKSs), EQ-5D, and satisfaction scores. Postoperative complications, the number of revisions, and the reasons causing them were collected. Results The mean follow-up was 48.7 (range 16-66) months. As compared to preoperative scores, OKS and Eq5d showed significant improvements (p<0.001). The satisfaction scores indicated that 28 patients (62%) were very satisfied, 10 (26.7%) were satisfied, and seven (15.5%) were dissatisfied. Four patients (8.9%) underwent revision surgery with a total knee replacement. Out of four patients requiring revision, two had progressive arthritis of the medial compartment, one had aseptic loosening of the implants, and one had trauma. Five patients showed persistent anteromedial knee pain (12.2%); one patient had maltracking requiring lateral release; one patient developed stiffness with knee flexion less than 60 degrees requiring manipulation under anesthesia. Conclusion Our results indicated that good or excellent functional outcomes can be expected in >80% of patients with survivorship of 91.1% at mid-term. Careful patient selection and counseling should be done informing of the risk of dissatisfaction/persistent pain and revision surgery in the mid and long term. Long-term outcomes and factors determining good outcomes need to be evaluated in future research.