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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
Knee

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

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

Notes

Acknowledgments

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.

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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

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