Smoking, unemployment, female sex, obesity, and medication use yield worse outcomes in patellofemoral arthroplasty

  • Vishal S. Desai
  • Ayoosh Pareek
  • Casey M. DeDeugd
  • Orlando D. Sabbag
  • Aaron J. Krych
  • Nancy M. Cummings
  • Diane L. DahmEmail author



The purpose of this study was to identify effects of psychosocial and demographic factors on patellofemoral arthroplasty (PFA) outcomes.


Patients who underwent PFA by a single surgeon between 2002 and 2013 (min. 2 year follow-up) were included. Knee Society scores (KSS), UCLA, and Tegner Scores were prospectively collected in a designated arthroplasty registry. Patient records were retrospectively reviewed and univariate and multivariate statistical analyses were performed to assess the effect of psychosocial factors and demographic variables including patient sex, BMI, smoking and medication use, psychiatric history, and employment status on improvement between pre- and post-operative scores.


Seventy-four knees in 55 patients (88% female) with a mean age of 51.8 (SD 8.8) and mean follow-up of 46.5 (SD 26.9) months were included. Patients showed significant improvement in all functional outcomes (p < 0.001). Mean improvement in KSS-F scores and median improvement in Tegner scores was greater in males compared to females (37.8 vs 16.1, p = 0.007; 3.0 vs 2.0, p = 0.07, respectively). Smokers showed less improvement in KSS-P compared to non-smokers (17.2 vs 30.0, p = 0.028). Retired or employed patients had a greater mean improvement in KSS-F and median improvement in Tegner Scores compared to those were unemployed or on work disability (p = 0.022, p = 0.01). Patients who reported using opioids and/or anti-depressants pre-operatively showed less improvement in UCLA scores (p = 0.006). Obese patients showed less improvement in both KSS-F and Tegner score compared to non-obese patients (p = 0.009, p = 0.004).


Psychosocial factors influence the degree of improvement following PFA. Although patients showed overall improvement compared to their baseline scores, obese patients, smokers, unemployed/work disabled, and pre-operative use of opioids and/or anti-depressants were risk factors for decreased improvement… The consideration of psychosocial variables are clinically important when assessing a patient’s candidacy for PFA and improve pre-operative patient selection and counselling.

Level of evidence

Level IV.


Patellofemoral arthroplasty Psychosocial Employment Smoking Anti-depressant Opioids 



No funding sources were utilized in completing this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest pertinent to the contents of this manuscript.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


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Copyright information

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

Authors and Affiliations

  • Vishal S. Desai
    • 1
  • Ayoosh Pareek
    • 1
  • Casey M. DeDeugd
    • 1
  • Orlando D. Sabbag
    • 1
  • Aaron J. Krych
    • 1
  • Nancy M. Cummings
    • 1
    • 2
  • Diane L. Dahm
    • 1
    Email author
  1. 1.Department of Orthopedic SurgeryMayo ClinicRochesterUSA
  2. 2.Department of Orthopedic SurgeryMayo ClinicMinneapolisUSA

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