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

  • David Dejour
  • Mo SaffariniEmail author
  • Yves Malemo
  • Marco Pungitore
  • Jeremy Valluy
  • Luca Nover
  • Guillaume Demey
KNEE
  • 19 Downloads

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.

Keywords

Patellofemoral arthroplasty Patellofemoral arthritis PFA Trochlear dysplasia Patient selection 

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

Notes

Author 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.

Funding

The authors received no funding for this study.

Compliance with ethical standards

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.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Ramsay Général de Santé, Lyon-Ortho-Clinic, Clinique de la SauvegardeLyonFrance
  2. 2.ReSurg SANyonSwitzerland

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