Skip to main content
SpringerLink
Log in

Early outcomes of an anatomic trochlear-cutting patellofemoral arthroplasty: patient selection is key

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to report outcomes of a recent anatomic trochlear-cutting patellofemoral arthroplasty (PFA) system at > 3 years. The hypothesis was that its functional scores and revision rates would be at least equivalent to those reported for other ‘trochlear-cutting’ implants in the literature.

Methods

Twenty-eight consecutive patients that had received PFA using the same anatomic trochlear-cutting implant (KneeTech PFJ, Corin-Tornier, Montbonnot, France) with a dome-shaped patellar button and had systematic lateral facetectomy without lateral release were enrolled. Radiographic parameters collected pre-operatively included: trochlear dysplasia type and patellar height, TT–TG, patellar tilt and shape. Clinical scores collected pre-operatively and at > 3 years included: Oxford Knee Score (OKS) and Knee Society Score (KSS).

Results

The initial cohort comprised 23 women (82%) and five men (18%), aged 63.3 ± 14.7 years, of which 23 had trochlear dysplasia (82%). One patient (4%) could not be reached, and three (11%) were revised to TKA due to arthritic progression, aged 77, 80 and 83 years at index operation, only one of which had trochlear dysplasia (type A). At final follow-up, none of the remaining 24 patients had complications; their OKS was 35.0 ± 10.3 and KSS symptoms and function were 19.8 ± 5.0 and 71.7 ± 13.6.

Conclusion

The anatomic trochlear-cutting PFA granted satisfactory scores and prevented mechanical complications, but the high incidence of early revisions, all due to spread of arthritis hence to improper patient selection. PFA should be restricted to patients with trochlear dysplasia, in whom arthritis was triggered by patellar instability and maltracking rather than degenerative or age-related diseases.

Study design

Retrospective case series, Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

PFA:

Patellofemoral arthroplasty

TKA:

Total knee arthroplasty

PFJ:

Patellofemoral joint

CDI:

Caton–Deschamps Index

TT–TG:

Tibial tuberosity to trochlear groove distance

OKS:

Oxford Knee Score

KSS:

Knee Society Score

KOOS:

Knee injury and Osteoarthritis Outcome Score

OA:

Osteoarthritis

References

  1. Borus T, Brilhault J, Confalonieri N, Johnson D, Thienpont E (2014) Patellofemoral joint replacement, an evolving concept. Knee 21(Suppl 1):S47–S50

    Article  PubMed  Google Scholar 

  2. Bunyoz KI, Lustig S, Troelsen A (2018) Similar postoperative patient-reported outcome in both second generation patellofemoral arthroplasty and total knee arthroplasty for treatment of isolated patellofemoral osteoarthritis: a systematic review. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5151-8

    Article  PubMed  Google Scholar 

  3. Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 68(5):317–325

    CAS  PubMed  Google Scholar 

  4. Chan KC, Gill GS (1999) Postoperative patellar tilt in total knee arthroplasty. J Arthroplasty 14(3):300–304

    Article  CAS  PubMed  Google Scholar 

  5. Charalambous CP, Abiddin Z, Mills SP, Rogers S, Sutton P, Parkinson R (2011) The low contact stress patellofemoral replacement: high early failure rate. J Bone Jt Surg Br 93(4):484–489

    Article  CAS  Google Scholar 

  6. Dahm DL, Al-Rayashi W, Dajani K, Shah JP, Levy BA, Stuart MJ (2010) Patellofemoral arthroplasty versus total knee arthroplasty in patients with isolated patellofemoral osteoarthritis. Am J Orthop (Belle Mead NJ) 39(10):487–491

    Google Scholar 

  7. Dahm DL, Kalisvaart MM, Stuart MJ, Slettedahl SW (2014) Patellofemoral arthroplasty: outcomes and factors associated with early progression of tibiofemoral arthritis. Knee Surg Sports Traumatol Arthrosc 22(10):2554–2559

    Article  PubMed  Google Scholar 

  8. de Deugd CM, Pareek A, Krych AJ, Cummings NM, Dahm DL (2017) Outcomes of patellofemoral arthroplasty based on radiographic severity. J Arthroplasty 32(4):1137–1142

    Article  Google Scholar 

  9. Dejour D, Ferrua P, Ntagiopoulos PG, Radier C, Hulet C, Remy F, Chouteau J, Chotel F, Boisrenoult P, Sebilo A, Guilbert S, Bertin D, Ehkirch FP, Chassaing V (2013) The introduction of a new MRI index to evaluate sagittal patellofemoral engagement. Orthop Traumatol Surg Res 99(8 Suppl):S391–S398

    Article  CAS  PubMed  Google Scholar 

  10. Dy CJ, Franco N, Ma Y, Mazumdar M, McCarthy MM, Gonzalez Della Valle A (2012) Complications after patello-femoral versus total knee replacement in the treatment of isolated patello-femoral osteoarthritis. A meta-analysis. Knee Surg Sports Traumatol Arthrosc 20(11):2174–2190

    Article  CAS  PubMed  Google Scholar 

  11. Hingelbaum S, Best R, Huth J, Wagner D, Bauer G, Mauch F (2014) The TT–TG Index: a new knee size adjusted measure method to determine the TT–TG distance. Knee Surg Sports Traumatol Arthrosc 22(10):2388–2395

    Article  PubMed  Google Scholar 

  12. Imhoff AB, Feucht MJ, Bartsch E, Cotic M, Pogorzelski J (2018) High patient satisfaction with significant improvement in knee function and pain relief after mid-term follow-up in patients with isolated patellofemoral inlay arthroplasty. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5173-2

    Article  PubMed  Google Scholar 

  13. Iwano T, Kurosawa H, Tokuyama H, Hoshikawa Y (1990) Roentgenographic and clinical findings of patellofemoral osteoarthrosis. With special reference to its relationship to femorotibial osteoarthrosis and etiologic factors. Clin Orthop Relat Res 252:190–197

    Google Scholar 

  14. Leadbetter WB, Kolisek FR, Levitt RL, Brooker AF, Zietz P, Marker DR, Bonutti PM, Mont MA (2009) Patellofemoral arthroplasty: a multi-centre study with minimum 2-year follow-up. Int Orthop 33(6):1597–1601

    Article  PubMed  Google Scholar 

  15. Lim JW, Chen JY, Chong HC, Pang HN, Tay DKJ, Chia SL, Lo NN, Yeo SJ (2018) Pre-existing patellofemoral disease does not affect 10-year survivorship in fixed bearing unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5169-y

    Article  PubMed  Google Scholar 

  16. Lonner JH (2008) Patellofemoral arthroplasty: the impact of design on outcomes. Orthop Clin N Am 39(3):347–354

    Article  Google Scholar 

  17. Lonner JH (2017) Patellofemoral arthroplasty: an evolving science. Instr Course Lect 66:211–221

    PubMed  Google Scholar 

  18. Middleton SWF, Toms AD, Schranz PJ, Mandalia VI (2018) Mid-term survivorship and clinical outcomes of the Avon patellofemoral joint replacement. Knee 25(2):323–328

    Article  CAS  PubMed  Google Scholar 

  19. Mont MA, Johnson AJ, Naziri Q, Kolisek FR, Leadbetter WB (2012) Patellofemoral arthroplasty: 7-year mean follow-up. J Arthroplasty 27(3):358–361

    Article  PubMed  Google Scholar 

  20. Nicol SG, Loveridge JM, Weale AE, Ackroyd CE, Newman JH (2006) Arthritis progression after patellofemoral joint replacement. Knee 13(4):290–295

    Article  PubMed  Google Scholar 

  21. Odgaard A, Madsen F, Kristensen PW, Kappel A, Fabrin J (2018) The Mark Coventry Award: patellofemoral arthroplasty results in better range of movement and early patient-reported outcomes than TKA. Clin Orthop Relat Res 476(1):87–100

    Article  PubMed  Google Scholar 

  22. Odumenya M, McGuinness K, Achten J, Parsons N, Spalding T, Costa M (2011) The Warwick patellofemoral arthroplasty trial: a randomised clinical trial of total knee arthroplasty versus patellofemoral arthroplasty in patients with severe arthritis of the patellofemoral joint. BMC Musculoskelet Disord 12:265

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ogura T, Le K, Merkely G, Bryant T, Minas T (2018) A high level of satisfaction after bicompartmental individualized knee arthroplasty with patient-specific implants and instruments. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5155-4

    Article  PubMed  PubMed Central  Google Scholar 

  24. Osarumwense D, Syed F, Nzeako O, Akilapa S, Zubair O, Waite J (2017) Patellofemoral joint arthroplasty: early results and functional outcome of the Zimmer gender solutions patello-femoral joint system. Clin Orthop Surg 9(3):295–302

    Article  PubMed  PubMed Central  Google Scholar 

  25. Patel A, Haider Z, Anand A, Spicer D (2017) Early results of patellofemoral inlay resurfacing arthroplasty using the HemiCap Wave prosthesis. J Orthop Surg (Hong Kong) 25(1):2309499017692705

    Article  Google Scholar 

  26. Perrone FL, Baron S, Suero EM, Lausmann C, Kendoff D, Zahar A, Gehrke T, Citak M (2018) Patient-reported outcome measures (PROMs) in patients undergoing patellofemoral arthroplasty and total knee replacement: a comparative study. Technol Health Care 26(3):507–514

    Article  PubMed  Google Scholar 

  27. Reihs B, Reihs F, Labek G, Hochegger M, Leithner A, Bohler N, Sadoghi P (2018) No bias for developer publications and no difference between first-generation trochlear-resurfacing versus trochlear-cutting implants in 15,306 cases of patellofemoral joint arthroplasty. Knee Surg Sports Traumatol Arthrosc 26(9):2809–2816

    Article  PubMed  Google Scholar 

  28. Saffarini M, Muller JH, La Barbera G, Hannink G, Cho KJ, Toanen C, Dejour D (2018) Inadequacy of computed tomography for pre-operative planning of patellofemoral arthroplasty. Knee Surg Sports Traumatol Arthrosc 26(5):1485–1492

    Article  PubMed  Google Scholar 

  29. Saffarini M, Ntagiopoulos PG, Demey G, Le Negaret B, Dejour DH (2014) Evidence of trochlear dysplasia in patellofemoral arthroplasty designs. Knee Surg Sports Traumatol Arthrosc 22(10):2574–2581

    Article  PubMed  Google Scholar 

  30. Saggin PR, Saggin JI, Dejour D (2012) Imaging in patellofemoral instability: an abnormality-based approach. Sports Med Arthrosc Rev 20(3):145–151

    Article  PubMed  Google Scholar 

  31. Valoroso M, Saffarini M, La Barbera G, Toanen C, Hannink G, Nover L, Dejour DH (2017) Correction of patellofemoral malalignment with patellofemoral arthroplasty. J Arthroplasty 32(12):3598–3602

    Article  PubMed  Google Scholar 

  32. van der List JP, Chawla H, Villa JC, Pearle AD (2017) Why do patellofemoral arthroplasties fail today? A systematic review. Knee 24(1):2–8

    Article  PubMed  Google Scholar 

  33. van der List JP, Chawla H, Zuiderbaan HA, Pearle AD (2016) Survivorship and functional outcomes of patellofemoral arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 25(8):2622–2631

    Article  Google Scholar 

  34. Vandenneucker H, Labey L, Vander Sloten J, Desloovere K, Bellemans J (2016) Isolated patellofemoral arthroplasty reproduces natural patellofemoral joint kinematics when the patella is resurfaced. Knee Surg Sports Traumatol Arthrosc 24(11):3668–3677

    Article  PubMed  Google Scholar 

  35. Wiberg G (1941) Roentgenographic and anatomic studies on the femoropatellar joint, with special reference to chondromalacia patellae. Acta Orthop Scand 12:319–410

    Article  Google Scholar 

  36. Zicaro JP, Yacuzzi C, Astoul Bonorino J, Carbo L, Costa-Paz M (2017) Patellofemoral arthritis treated with resurfacing implant: clinical outcome and complications at a minimum two-year follow-up. Knee 24(6):1485–1491

    Article  PubMed  Google Scholar 

Download references

Funding

The authors received no funding for this study.

Author information

Authors and Affiliations

  1. Ramsay Général de Santé, Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 29 avenue des Sources, 69009, Lyon, France

    David Dejour, Yves Malemo, Marco Pungitore & Guillaume Demey

  2. ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland

    Mo Saffarini, Jeremy Valluy & Luca Nover

Authors
  1. David Dejour
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mo Saffarini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yves Malemo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marco Pungitore
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeremy Valluy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luca Nover
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Guillaume Demey
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DD participated in study design, data collection and manuscript writing. MS participated in study design, literature review and manuscript writing. YM participated in data collection, literature review and manuscript editing. MP participated in data collection literature review and manuscript editing. JV participated in statistical analysis, literature review, and manuscript writing. LN participated in statistical analysis, table preparation and manuscript writing. GD participated in study design, data collection and manuscript editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mo Saffarini.

Ethics declarations

Conflict of interest

Dr. Dejour received royalties from Tornier-Corin.

Ethical approval

The ethical committee of the Clinique de la Sauvegarde approved the study protocol in advance.

Informed consent

All patients provided written informed consent for the use of their data and images for research and publishing purposes.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dejour, D., Saffarini, M., Malemo, Y. et al. Early outcomes of an anatomic trochlear-cutting patellofemoral arthroplasty: patient selection is key. Knee Surg Sports Traumatol Arthrosc 27, 2297–2302 (2019). https://doi.org/10.1007/s00167-019-05368-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-019-05368-8

Keywords

Search

Navigation