Complications after patello-femoral versus total knee replacement in the treatment of isolated patello-femoral osteoarthritis. A meta-analysis
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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.
KeywordsPatellofemoral 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.
- 2.Arciero RA, Toomey HE (1988) Patellofemoral arthroplasty: a three- to nine-year follow-up study. Clin Orthop Rel Res 236:60–71Google Scholar
- 4.Arnbjörnsson AH, Ryd L (1998) The use of isolated patellar prostheses in Sweden 1977–1986. Int Ortop 22:141–144Google Scholar
- 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.Cochran WG (1954) The combination of estimates from different experiment. Biometrics 10(1):101–129Google Scholar
- 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
- 19.Laskin RS, van Steijn M (2009) Total knee replacement for patients with patellofemoral arthritis. Clin Orthop Rel Res 367:89–95Google Scholar
- 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
- 24.Lubinus HH (1979) Patella glide bearing total replacement. Orthopedics 2:119–127Google Scholar
- 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.Merchant AC (2005) A modular prosthesis for patellofemoral arthroplasty: design and initial results. Clin Orthop Rel Res 36:40–46Google Scholar
- 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
- 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