Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 9, pp 2784–2791 | Cite as

A matched-pair comparison of inlay and onlay trochlear designs for patellofemoral arthroplasty: no differences in clinical outcome but less progression of osteoarthritis with inlay designs

  • Matthias J. Feucht
  • Matthias Cotic
  • Knut Beitzel
  • Julia F. Baldini
  • Gebhart Meidinger
  • Philip B. Schöttle
  • Andreas B. Imhoff



To compare clinical and radiographic results after isolated patellofemoral arthroplasty (PFA) using either a second-generation inlay or onlay trochlear design. The hypothesis was that an inlay design will produce better clinical results and less progression of tibiofemoral osteoarthritis (OA) compared to an onlay design.


Fifteen consecutive patients undergoing isolated PFA with an onlay design trochlear component (Journey™ PFJ, Smith & Nephew) were matched with 15 patients after isolated PFA with an inlay design trochlear component (HemiCAP® Wave, Arthrosurface). Matching criteria were age, gender, body mass index, and follow-up period. An independent observer evaluated patients prospectively, whereas data were compared retrospectively. Clinical outcome was assessed using WOMAC, Lysholm score, and pain VAS. Kellgren–Lawrence grading was used to assess progression of tibiofemoral OA.


Conversion to total knee arthroplasty was necessary in one patient within each group, leaving 14 patients per group for final evaluation. The mean follow-up was 26 months in the inlay group and 25 months in the onlay group (n.s.). Both groups displayed significant improvements of all clinical scores (p < 0.05). No significant differences were found between the two groups with regard to the clinical outcome and reoperation rate. No significant progression of tibiofemoral OA was observed in the inlay group, whereas 53 % of the onlay group showed progression of medial and/or lateral tibiofemoral OA (p = 0.009).


Isolated PFA using either a second-generation inlay or onlay trochlear component significantly improves functional outcome scores and pain. The theoretical advantages of an inlay design did not result in better clinical outcome scores; however, progression of tibiofemoral OA was significantly less common in patients with an inlay trochlear component. This implant design may therefore improve long-term results and survival rates after isolated PFA.

Level of evidence



Patellofemoral arthritis Patellofemoral arthroplasty Inlay Onlay HemiCAP Wave Journey PFJ 


Compliance with ethical standards

Conflict of interest

A. B. Imhoff and P. B. Schöttle are consultants for Arthrosurface. The company had no influence on study design, data collection, and interpretation of the results or the final manuscript.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Matthias J. Feucht
    • 1
    • 2
  • Matthias Cotic
    • 1
  • Knut Beitzel
    • 1
  • Julia F. Baldini
    • 1
  • Gebhart Meidinger
    • 1
    • 3
  • Philip B. Schöttle
    • 1
    • 4
  • Andreas B. Imhoff
    • 1
  1. 1.Department of Orthopaedic Sports MedicineTechnical University MunichMunichGermany
  2. 2.Department of Orthopedic Surgery and TraumatologyFreiburg University HospitalFreiburgGermany
  3. 3.Department of Trauma and Orthopaedic SurgeryTrauma Center MurnauMurnauGermany
  4. 4.Department of Orthopaedics and Trauma SurgeryIsar Medical CenterMunichGermany

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