Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 20, Issue 11, pp 2174–2190 | Cite as

Complications after patello-femoral versus total knee replacement in the treatment of isolated patello-femoral osteoarthritis. A meta-analysis

  • C. J. DyEmail author
  • N. Franco
  • Y. Ma
  • M. Mazumdar
  • M. M. McCarthy
  • A. Gonzalez Della Valle



Both patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA) are successful in treating isolated patellofemoral osteoarthritis, but the complication rates after PFA are concerning. We performed a meta-analysis to compare the incidence of complications, re-operations, and revision following PFA and TKA for patellofemoral osteoarthritis.


We systematically identified publications with patients who underwent PFA or TKA for patellofemoral osteoarthritis with minimum 1.5 year follow-up. Demographics, implant (TKA, first [1G] or second-generation [2G] PFA), complications, and cause of re-operations were extracted. Random-effects meta-analysis was used to pool incidence data, which was compared between groups using logistic regression to adjust for length of follow-up.


Twenty-eight observational studies and no randomized trials were included in this meta-analysis, which limits its generalizability. There was a higher likelihood of any re-operation (odds ratio 8.06) and revision (OR 8.11) in PFA compared to TKA. Re-operation (OR 4.33) and revision (OR 4.93) were more likely in 1G-PFA than 2G-PFA. When comparing 2G-PFA to TKA, there was no significant difference in re-operation, revision, pain, or mechanical complications.


Patients who undergo PFA rather than TKA are more likely to experience complications and require re-operation or revision, but subgroup analysis suggests a relation to implant design. There is no significant difference in re-operation, revision, pain, or mechanical complications between 2G-PFA and TKA.

Level of evidence

Systematic review of Level III therapeutic studies, Level III.


Patellofemoral arthritis Patellofemoral arthroplasty Patellofemoral replacement Total knee replacement Total knee arthroplasty 



The authors would like to thank Mr. Soloman Melkman, whose generous contributions helped to fund the current study. The authors would like to thank Mr. Timothy Roberts and Miss Indira Garcia from the Medical Library at Hospital for Special Surgery for their assistance in gathering articles for the meta-analysis; and Mr. Huibo Shao for his assistance in the statistical modeling. The authors would also like to thank Dr. Beth Shubin Stein for her critical review of the manuscript.

Conflict of interest

None of the authors have any potential conflicts of interest.


  1. 1.
    Ackroyd CE, Chir B (2005) Development and early results of a new patellofemoral arthroplasty. Clin Orthop Relat Res 436:7–13PubMedCrossRefGoogle Scholar
  2. 2.
    Arciero RA, Toomey HE (1988) Patellofemoral arthroplasty: a three- to nine-year follow-up study. Clin Orthop Rel Res 236:60–71Google Scholar
  3. 3.
    Argenson JA, Flecher X, Parratte S, Aubaniac J (2005) Patellofemoral arthroplasty: an update. Clin Orthop Rel Res 440:50–53CrossRefGoogle Scholar
  4. 4.
    Arnbjörnsson AH, Ryd L (1998) The use of isolated patellar prostheses in Sweden 1977–1986. Int Ortop 22:141–144Google Scholar
  5. 5.
    Blazina ME, Fox JM, Del Pizzo W, Broukhim B, Ivey FM (1979) Patellofemoral replacement. Clin Orthop 144:98–102PubMedGoogle Scholar
  6. 6.
    Butler JE, Shannon R (2009) Patellofemoral arthroplasty with a custom-fit femoral prosthesis. Orthopedics 32:81PubMedGoogle Scholar
  7. 7.
    Cartier P, Sanouiller J, Khefacha A (2005) Long-term results with the first patellofemoral prosthesis. Clin Orthop Rel Res 436:47–54Google Scholar
  8. 8.
    Cochran WG (1954) The combination of estimates from different experiment. Biometrics 10(1):101–129Google Scholar
  9. 9.
    Dalury DF (2005) Total knee replacement for patellofemoral disease. J Knee Surg 18:274–277PubMedGoogle Scholar
  10. 10.
    de Cloedt P, Legaye J, Lokietek W (1999) Femoro-patellar prosthesis. A retrospective study of 45 consecutive cases with a follow-up of 3–12 years. Acta Orthop Belg 65:170–175PubMedGoogle Scholar
  11. 11.
    de Winter WE, Feith R, van Loon CJM (2001) The Richards type II patellofemoral arthroplasty: 26 cases followed for 1–20 years. Acta Orthop Scand 72:487–490PubMedCrossRefGoogle Scholar
  12. 12.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188PubMedCrossRefGoogle Scholar
  13. 13.
    Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634PubMedCrossRefGoogle Scholar
  14. 14.
    Freeman MF, Tukey JW (1950) Transformations related to the angular and the square root. Ann Math Statist 21:607–611CrossRefGoogle Scholar
  15. 15.
    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558PubMedCrossRefGoogle Scholar
  16. 16.
    Jørgensen PS, Konradsen LA, Mati WB, Tørholm C (2007) Treatment of patellofemoral arthritis with patello-femoral arthroplasties. Ugeskr Laeger 169:2201–2204PubMedGoogle Scholar
  17. 17.
    Kooijman HJ, Driessen APPM, van Horn JR (2003) Long-term results of patellofemoral arthroplasty: a report of 56 arthroplasties with 17 years of follow-up. J Bone Jt Surg Br 85-B:836–840Google Scholar
  18. 18.
    Krajca-Radcliffe J, Coker TP (1996) Patellofemoral arthroplasty: a 2- to 18-year followup study. Clin Orthop Rel Res 330:143–151CrossRefGoogle Scholar
  19. 19.
    Laskin RS, van Steijn M (2009) Total knee replacement for patients with patellofemoral arthritis. Clin Orthop Rel Res 367:89–95Google Scholar
  20. 20.
    Leadbetter WB, Kolisek FR, Levitt RL et al (2009) Patellofemoral arthroplasty: a multi-centre study with minimum 2-year follow-up. Int Orthop 33:1597–1601PubMedCrossRefGoogle Scholar
  21. 21.
    Leadbetter WB, Ragland PS, Mont MA (2005) The appropriate use of patellofemoral arthroplasty: an analysis of reported indications, contraindications, and failures. Clin Orthop Rel Res 436:91–99Google Scholar
  22. 22.
    Lonner JH (2008) Patellofemoral arthroplasty: the impact of design on outcomes. Orthop Clin North Am 39:347–354PubMedCrossRefGoogle Scholar
  23. 23.
    Lonner JH (2004) Patellofemoral arthroplasty: pros, cons, and design considerations. Clin Orthop Rel Res 428:158–165CrossRefGoogle Scholar
  24. 24.
    Lubinus HH (1979) Patella glide bearing total replacement. Orthopedics 2:119–127Google Scholar
  25. 25.
    Meding JA, Wing JT, Keating EM, Ritter MA (2007) Total knee arthroplasty for isolated patellofemoral arthritis in younger patients. Clin Orthop Rel Res 464:78–82Google Scholar
  26. 26.
    Merchant AC (2005) A modular prosthesis for patellofemoral arthroplasty: design and initial results. Clin Orthop Rel Res 36:40–46Google Scholar
  27. 27.
    Mertl P, Van FT, Bonhomme P, Vives P (1997) Femoropatellar osteoarthritis treated by prosthesis. Retrospective study of 50 implants. Rev Chir Orthop Reparatrice Appar Mot 83:712–718PubMedGoogle Scholar
  28. 28.
    Mihalko WM, Boachie-Adjei Y, Spang JT, Fulkerson JP, Arendt EA, Saleh KJ (2007) Controversies and techniques in the surgical management of patellofemoral arthritis. J Bone Jt Surg Am 89:2788–2802Google Scholar
  29. 29.
    Mohammed R, Jimulia T, Durve K, Bansal M, Green M, Learmonth D (2008) Medium-term results of patellofemoral joint arthroplasty. Acta Orthop Belg 74:472–477PubMedGoogle Scholar
  30. 30.
    Mont MA, Haas S, Mullick T, Hungerford DS (2002) Total knee arthroplasty for patellofemoral arthritis. J Bone Jt Surg Am 84:1977–1981Google Scholar
  31. 31.
    Odumenya M, Costa ML, Parsons N, Achten J, Dhillon M, Krikler SJ (2010) The Avon patellofemoral joint replacement: five-year results from an independent centre. J Bone Jt Surg Br 92-B:56–60CrossRefGoogle Scholar
  32. 32.
    Parvizi J, Stuart MJ, Pagnano MW, Hanssen AD (2001) Total knee arthroplasty in patients with isolated patellofemoral arthritis. Clin Orthop Rel Res 392:147–152CrossRefGoogle Scholar
  33. 33.
    Sisto DJ, Sarin VK (2006) Custom patellofemoral arthroplasty of the knee. J Bone Jt Surg Am 88:1475–1480CrossRefGoogle Scholar
  34. 34.
    Slim K, Nini E, Forestier D, Kwiatkoski F, Panis Y, Chipponi J (2003) Methodolical index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73:712–716PubMedCrossRefGoogle Scholar
  35. 35.
    Smith AM, Peckett WRC, Butler-Manuel PA, Venu KM, d’Arcy JC (2002) Treatment of patello-femoral arthritis using the Lubinus patello-femoral arthroplasty: a retrospective review. Knee 9:27–30PubMedCrossRefGoogle Scholar
  36. 36.
    Stroup DF, Berlin JA, Moron SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 283:2008–2012PubMedCrossRefGoogle Scholar
  37. 37.
    Tauro B, Ackroyd CE, Newman JH, Shah NA (2001) The Lubinus patellofemoral arthroplasty: a five- to ten-year prospective study. J Bone Jt Surg Br 83-B:696–701CrossRefGoogle Scholar
  38. 38.
    Thompson NW, Ruiz AL, Breslin E, Beverland DE (2001) Total knee arthroplasty without patellar resurfacing in isolated patellofemoral osteoarthritis. J Arthroplast 5:607–612CrossRefGoogle Scholar
  39. 39.
    Utukuri MM, Khanduja V, Somayaji HS, Dowd GSE (2008) Patient-based outcomes in patellofemoral arthroplasty. J Knee Surg 21:269–274PubMedCrossRefGoogle Scholar
  40. 40.
    van Jonbergen H, Poolman RW, van Kampen A (2010) Isolated patellofemoral osteoarthritis: a systematic review of treatment options using the GRADE approach. Acta Orthop 81:199–205PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • C. J. Dy
    • 1
    Email author
  • N. Franco
    • 1
  • Y. Ma
    • 1
  • M. Mazumdar
    • 2
  • M. M. McCarthy
    • 1
  • A. Gonzalez Della Valle
    • 1
  1. 1.Department of Orthopaedic SurgeryHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Public HealthWeill Cornell Medical CollegeNew YorkUSA

Personalised recommendations