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Severe patellofemoral arthritis does not compromise 6-month post-operative range of motion or function following unicondylar knee arthroplasty

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

The presence of significant patellofemoral arthritis (PFA) is still considered a contraindication for unicondylar knee arthroplasty (UKA) by many surgeons. The purpose of this study was to determine if the presence of severe PFA at the time of UKA compromised early (< 6 months) post-operative knee range of motion or functional outcomes.

Methods

This retrospective review evaluated unilateral and bilateral UKA (323 patients; 418 knees) between 2015 and 2019. Procedures were grouped by degree of PFA present at the time of surgery, including mild PFA (Group 1; N = 266), moderate to severe PFA (Group 2; N = 101), and severe PFA with lateral compartment bone-on-bone contact (Group 3; N = 51). Knee range of motion and Knee Society Knee (KSS-K) and Function (KSS-F) scores were collected both before and at 6 months following surgery. Group differences were evaluated with Kruskal–Wallis and Chi-square tests for continuous and categorical variables, respectively. Univariate and multivariable logistic regressions were performed to determine influential variables associated with post-operative knee flexion being ≤ 120° and presented as odds ratios (OR) and 95% confidence intervals (CI).

Results

Pre-operative flexion was lowest in Group 3 (p = 0.010) with 17.6% of knees having flexion ≤ 120°. Post-operative flexion was lowest in Group 3 (119.1° ± 8.4°, p = 0.003) with 19.6% knees having flexion ≤ 120° compared to 9.8% and 8.9% in Groups 1 and 2, respectively. No significant difference in KSS-F following surgery was found; all three groups demonstrated similar clinical improvement. Increased age (OR 1.089, CI 1.036–1.144; p = 0.001) and body mass index (OR 1.082, CI 1.006–1.163; p = 0.034) were found to be associated with post-operative knee flexion ≤ 120°, while high pre-operative flexion (OR 0.949, CI 0.921–0.978; p = 0.001) was found to be inversely associated with poor knee flexion following surgery.

Conclusion

Patients with severe PFA demonstrate similar clinical improvement following UKA at 6 months as patients with less severe PFA.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or non-for-profit sectors.

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Authors and Affiliations

  1. University of Hawai’I, John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA

    Dylan Singh & Dylan Lawton

  2. Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA

    Dylan Lawton, Donna L. M. T. Au & Cass K. Nakasone

  3. Department of Surgery, University of Hawai’i, John A Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA

    Cass K. Nakasone

  4. Office of Public Health Studies, University of Hawai’I, 1960 East-West Road, Honolulu, HI, 96822, USA

    Rosana Hernandez Weldon

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  1. Dylan Singh
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Correspondence to Cass K. Nakasone.

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Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Hawaii Pacific Health Research Institute (local Western Institutional Review Board) approved this study. IRB Tracking Number 20190840.

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This was a retrospective chart review and data collected were deidentified and presented as large-scale, aggregate data. Therefore, no informed consent was obtained or required by the IRB.

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Singh, D., Lawton, D., Weldon, R.H. et al. Severe patellofemoral arthritis does not compromise 6-month post-operative range of motion or function following unicondylar knee arthroplasty. Arch Orthop Trauma Surg 143, 6791–6797 (2023). https://doi.org/10.1007/s00402-023-04978-9

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  • DOI: https://doi.org/10.1007/s00402-023-04978-9

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