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Patellofemoral arthroplasty: obesity linked to high risk of revision and progression of medial tibiofemoral osteoarthritis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to determine the effect of obesity on patient outcome, procedure failure rate and osteoarthritis (OA) progression in the tibiofemoral compartments in a series of isolated patellofemoral arthroplasty (PFA) performed with a third-generation implant.

Methods

The study population was patients who had undergone third-generation PFA at a specialized orthopedic center between 2007 and 2017. Patients were categorized by body-mass index (BMI) as obese (O, BMI > 30 kg/m2) or nonobese (NO, BMI < 30 kg/m2). Preoperative and postoperative clinical and functional assessment included knee range of motion, Knee Society Score (KSS), University of California Los Angeles (UCLA) Activity Score, Tegner Activity Level Scale, and visual analogue scale (VAS) for pain. Preoperative and postoperative radiographs were evaluated for progression of tibiofemoral compartment OA, changes in patellar height and in knee coronal alignment. Multiple logistic regression models were used to assess the effect of BMI on outcomes together with other covariates.

Results

A total of 120 PFAs with a mean follow-up of 6.9 ± 2.5 years were included: 25 in the O group and 95 in the NO group. Significant improvement was noted in in knee range of motion (P < 0.001), clinical and functional KSS (P < 0.001), UCLA Activity Score (P < 0.001), Tegner score (P < 0.001) and VAS pain (P < 0.001) without inter-groups differences. Worsening of the medial Kellgren–Lawrence (KL) grade (but not the lateral KL grade) was more frequent in the O than the NO group during the follow-up period (P = 0.014). Failure occurred in 4.2% of NO and in 20% of O group patients; the difference was solely due to failure because of OA progression in the tibiofemoral compartment (16% in the O group). There were no between group differences in the failure rate for any cause other than OA progression (4.2% in the NO group, 4.0% in the O group).

Conclusions

An equal improvement in function after PFA was noted in both obese and nonobese patients; however, the high failure rate due to OA progression in the medial tibiofemoral compartment warrants caution when considering PFA in obese patients.

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Abbreviations

PFA:

Patellofemoral arthroplasty

TKA:

Total knee arthroplasty

OA:

Osteoarthritis

ROM:

Range of motion

BMI:

Body mass index

VAS:

Visual analogue scale

KL:

Kellgren–Lawrence

KSS:

Knee Society score

UCLA:

University of California Los Angeles Activity Score

HKA:

Hip–knee–ankle angle

O:

Obese

NO:

Non obese

OR:

Odds ratio

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Funding

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Authors and Affiliations

  1. Department of Joint Replacement, IRCCS Istituto Ortopedico Galeazzi, via R. Galeazzi 4, 20161, Milan, Italy

    Matteo Marullo, Marco Bargagliotti, Claudio Lacagnina & Sergio Romagnoli

  2. Orthopaedic Biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Marco Vigano’

Authors
  1. Matteo Marullo
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  2. Marco Bargagliotti
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  3. Marco Vigano’
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  4. Claudio Lacagnina
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  5. Sergio Romagnoli
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Contributions

MM was involved with study design, data collection, drafting, editing and reviewing of the manuscript; MB was involved with drafting and reviewing of the manuscript. CL was involved with data collection and drafting of the manuscript. MV was involved with statistical analysis, drafting, editing and reviewing of the manuscript. SR was involved with drafting and reviewing of the manuscript. All contributors met the ICMJE and journal criteria for authorship and approved the final manuscript.

Corresponding author

Correspondence to Matteo Marullo.

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Conflict of interest

Dr. Romagnoli is a paid consultant and receives royalties from Zimmer Biomet. The other authors reported no conflict of interest.

Ethical approval

The study was approved by the Ethical Committee of the IRCCS Ospedale San Raffaele (reference number: 134/INT/2017).

Informed consent

Informed consent was obtained from all the participants who were included in the study.

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Marullo, M., Bargagliotti, M., Vigano’, M. et al. Patellofemoral arthroplasty: obesity linked to high risk of revision and progression of medial tibiofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 30, 4115–4122 (2022). https://doi.org/10.1007/s00167-022-06947-y

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  • DOI: https://doi.org/10.1007/s00167-022-06947-y

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