Abstract
Background
Both Patellofemoral Arthroplasty (PFA) and Total Knee Arthroplasty (TKA) are accepted surgical options for end-stage isolated patellofemoral osteoarthritis (PFOA). We performed a systematic review and meta-analysis to compare outcomes of PFA and TKA by evaluation of the patient-reported outcome measures (PROMs).
Methods
We systematically identified publications reporting on patients that underwent either TKA or modern PFA for isolated PFOA. Meta-analysis software was used to screen for potential articles with at least two years’ follow-up. Data were extracted and analysed for all PROMs operating time, postoperative inpatient time, complications and cost. We included five studies in our cumulative meta-analysis and reviewed them using Review Manager V.5.0. We computed the risk ratio as a measure of the treatment effect, taking into account heterogeneity. We used random-effect models.
Results
No significant difference was found between both TKA and PFA in the context of operating time. No significant difference after five years’ follow-up was found between the two treatment options in terms of UCLA score and patient satisfaction. PFA showed significant improvement in WOMAC score at five-year follow-up, less postoperative inpatient time, better cost-effectiveness and significantly less blood loss.
Conclusion
PFA seems to be a viable alternative to TKA for treatment of isolated PFOA in appropriately selected patients. PFA showed less postoperative inpatient time and blood loss with similar PROMs to the TKA. Moreover, it is an economically beneficial joint-preserving procedure.
Similar content being viewed by others
References
Fredborg C, Odgaard A, Sørensen J (2020) Patellofemoral arthroplasty is cheaper and more effective in the short term than total knee arthroplasty for isolated patellofemoral osteoarthritis: Cost-effectiveness analysis based on a randomized trial. Bone Jt J 102:449–457. https://doi.org/10.1302/0301-620X.102B4.BJJ-2018-1580.R3
Joseph MN, Achten J, Parsons NR, Costa ML (2020) The PAT randomized clinical trial. Bone Jt J 102:310–318. https://doi.org/10.1302/0301-620X.102B3.BJJ-2019-0723.R1
Wada K, Price A, Gromov K et al (2020) Clinical outcome of bi-unicompartmental knee arthroplasty for both medial and lateral femorotibial arthritis: a systematic review—is there proof of concept? Arch Orthop Trauma Surg 140:1503–1513. https://doi.org/10.1007/s00402-020-03492-6
Feucht MJ, Lutz PM, Ketzer C et al (2020) Preoperative patellofemoral anatomy affects failure rate after isolated patellofemoral inlay arthroplasty. Arch Orthop Trauma Surg 140:2029–2039. https://doi.org/10.1007/s00402-020-03651-9
Blazina ME, Fox JM, Del Pizzo W et al (2005) Patellofemoral replacement. Clin Orthop Relat Res 1979:3–6
Lubinus HH (1979) Patella glide bearing total replacement. Orthopedics 2:119–127. https://doi.org/10.3928/0147-7447-19790
Narkbunnam R, Electricwala AJ, Huddleston JI et al (2019) Suboptimal patellofemoral alignment is associated with poor clinical outcome scores after primary total knee arthroplasty. Arch Orthop Trauma Surg 139:249–254. https://doi.org/10.1007/s00402-018-3073-z
Lonner JH (2008) Patellofemoral arthroplasty: the impact of design on outcomes. Orthop Clin North Am 39(347–54):vi. https://doi.org/10.1016/j.ocl.2008.02.002
Lonner JH (2017) Patellofemoral arthroplasty: an evolving science. Instr Course Lect 66:211–221
Bohu Y, Klouche S, Sezer HB et al (2019) Hermes patellofemoral arthroplasty: annual revision rate and clinical results after two to 20 years of follow-up. Knee 26:484–491. https://doi.org/10.1016/j.knee.2019.01.014
Julian P.T. Higgins JT, Jacqueline Chandler, Miranda Cumpston TL, Welch MJP and VA (2019) Cochrane Handbook for Systematic Reviews of Interventions
Walker LC, Clement ND, Bardgett M et al (2018) The WOMAC score can be reliably used to classify patient satisfaction after total knee arthroplasty. Knee Surgery, Sport Traumatol Arthrosc 26:3333–3341. https://doi.org/10.1007/s00167-018-4879-5
(2014) RM (RevMan) [Computer P, Centre V 5. 3. CTNC, Collaboration. TC Review Manager V.5.0.
Lonner JH (2010) Patellofemoral arthroplasty. Orthopedics. https://doi.org/10.3928/01477447-20100722-39
Dy CJ, Franco N, Ma Y et al (2012) Complications after patello-femoral versus total knee replacement in the treatment of isolated patello-femoral osteoarthritis. A meta-analysis. Knee Surg Sport Traumatol Arthrosc 20:2174–2190. https://doi.org/10.1007/s00167-011-1677-8
Odgaard A, Madsen F, Kristensen PW et al (2018) The mark coventry award: Patellofemoral arthroplasty results in better range of movement and early patient-reported outcomes than TKA. Clin Orthop Relat Res 476:87–100. https://doi.org/10.1007/s11999.0000000000000017
Clement ND, Howard TA, Immelman RJ et al (2019) Patellofemoral arthroplasty versus total knee arthroplasty for patients with patellofemoral osteoarthritis equal function and satisfaction but higher revision rate for partial arthroplasty at a minimum eight years’ follow-up. Bone Jt J 101B:41–46. https://doi.org/10.1302/0301-620X.101B1.BJJ-2018-0654.R2
Dahm DL, Al-Rayashi W, Dajani K et al (2010) Patellofemoral arthroplasty versus total knee arthroplasty in patients with isolated patellofemoral osteoarthritis. Am J Orthop (Belle Mead NJ) 39:487–491
Chawla H, Nwachukwu BU, Van Der List JP et al (2017) Cost effectiveness of patellofemoral versus total knee arthroplasty in younger patients. Bone Jt J 99B:1028–1036. https://doi.org/10.1302/0301-620X.99B8.BJJ-2016-1032.R1
Lewis PL, Tudor F, Lorimer M et al (2020) Short-term revision risk of patellofemoral arthroplasty is high: an analysis from eight large arthroplasty registries. Clin Orthop Relat Res 478:1222–1231. https://doi.org/10.1097/CORR.0000000000001268
Leadbetter WB, Kolisek FR, Levitt RL et al (2009) Patellofemoral arthroplasty: a multi-centre study with minimum 2-year follow-up. Int Orthop 33:1597–1601. https://doi.org/10.1007/s00264-008-0692-y
Ackroyd CE, Chir B (2005) Development and early results of a new patellofemoral arthroplasty. Clin Orthop Relat Res 2:7–13. https://doi.org/10.1097/01.blo.0000171914.94503.d1
Ackroyd CE, Newman JH, Evans R et al (2007) The Avon patellofemoral arthroplasty. J Bone Joint Surg Br 89:310–315. https://doi.org/10.1302/0301-620X.89B3.18062
deDeugd CM, Pareek A, Krych AJ et al (2017) Outcomes of patellofemoral arthroplasty based on radiographic severity. J Arthroplasty 32:1137–1142. https://doi.org/10.1016/j.arth.2016.11.006
Ahearn N, Metcalfe AJ, Hassaballa MA et al (2016) The Journey patellofemoral joint arthroplasty: a minimum 5year follow-up study. Knee 23:900–904. https://doi.org/10.1016/j.knee.2016.03.004
Middleton SWF, Toms AD, Schranz PJ, Mandalia VI (2018) Mid-term survivorship and clinical outcomes of the Avon patellofemoral joint replacement. Knee 25:323–328. https://doi.org/10.1016/j.knee.2018.01.007
National Joint Registry for England, Wales NI and the I of M (2018) 15th Annual Report 2018. Annu Rep 1821:218. https://doi.org/https://doi.org/10.1038/nmat2505
Australian Orthopaedic Association National Joint Replacement Registry (2018) Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, knee & shoulder arthroplasty. Annual Report 2018:1–444
Bunyoz KI, Lustig S, Troelsen A (2019) Similar postoperative patient-reported outcome in both second generation patellofemoral arthroplasty and total knee arthroplasty for treatment of isolated patellofemoral osteoarthritis: a systematic review. Knee Surgery Sport Traumatol Arthrosc 27:2226–2237. https://doi.org/10.1007/s00167-018-5151-8
Delanois RE, McGrath MS, Ulrich SD et al (2008) Results of total knee replacement for isolated patellofemoral arthritis: when not to perform a patellofemoral arthroplasty. Orthop Clin North Am 39:381–388. https://doi.org/10.1016/j.ocl.2008.03.003
Woon CYL, Christ AB, Goto R et al (2019) Return to the operating room after patellofemoral arthroplasty versus total knee arthroplasty for isolated patellofemoral arthritis—a systematic review. Int Orthop 43:1611–1620. https://doi.org/10.1007/s00264-018-04280-z
Lonner JH, Jasko JG, Booth RE (2006) Revision of a failed patellofemoral arthroplasty to a total knee arthroplasty. J Bone Jt Surg 88:2337–2342. https://doi.org/10.2106/JBJS.F.00282
Sarda PK, Shetty A, Maheswaran SS (2011) Medium term results of Avon patellofemoral joint replacement. Indian J Orthop 45:439–444. https://doi.org/10.4103/0019-5413.83761
Parratte S, Lunebourg A, Ollivier M et al (2015) Are revisions of patellofemoral arthroplasties more like primary or revision TKAs. Clin Orthop Relat Res 473:213–219. https://doi.org/10.1007/s11999-014-3756-x
Christ AB, Baral E, Koch C et al (2017) Patellofemoral arthroplasty conversion to total knee arthroplasty: Retrieval analysis and clinical correlation. Knee 24:1233–1239. https://doi.org/10.1016/j.knee.2017.06.015
Funding
There is no funding source.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Conflict of Interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Elbardesy, H., McLeod, A., Gul, R. et al. Midterm results of modern patellofemoral arthroplasty versus total knee arthroplasty for isolated patellofemoral arthritis: systematic review and meta-analysis of comparative studies. Arch Orthop Trauma Surg 142, 851–859 (2022). https://doi.org/10.1007/s00402-021-03882-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-021-03882-4