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Purpose The purpose of this study was to evaluate the efect of preoperative patella alta on clinical outcomes, survivorship, and complication and reoperation rates on patellofemoral arthroplasty (PFA). Methods All patients who underwent PFA for isolated patellofemoral arthritis by a single surgeon at our institution were identiied. Preoperative radiographs were measured by two independent observers for patellar height using the Caton Deschamps (CD), Insall-Salvati (IS), and Blackburne-Peele (BP) methods. Patients were classiied as either "patella alta" or "non-patella alta" for all three measurement methods. Clinical scores including KSS Pain, KSS Function, and Tegner Activity Scores were collected pre-and post-operatively. Failure was deined as conversion to total knee arthroplasty (TKA). Clinical outcomes and survivorship were compared between patients with "patella alta" and "non-patella alta" height measurements. Results There were 119 patients with 153 knees (86% female) included in the study with a mean age of 55.8 years. Outcome scores improved from pre-operative to post-operative for both patella alta and non-patella alta patients for Tegner, KSS pain and KSS function scores. The mean change in Tegner scores for patella alta and non-patella alta patients were not signiicantly diferent for CD (p = 0.24), IS (p = 0.25) or BP measurements (p = 0.39). The mean change in KSS pain scores between groups were not signiicantly diferent for CD (p = 0.33) or IS measurements (p = 0.22), but was improved more signiicantly in patella alta patients vs non-patella alta patients (21.2 and 14.4; p = 0.02) for BP measurement. The mean change in KSS function scores between groups was not signiicantly diferent for CD (p = 0.61) IS (p = 0.90) or BP measurements (p = 0.79). The overall survivorship from conversion to total knee arthroplasty (TKA) was 94.1% at a mean follow-up time of 5.0 (SD 2.6) years. There were no signiicant diferences in survivorship from TKA between patella alta and non-patella alta groups (CD: p = 0.72, IS: p = 0.63, BP: p = 0.66). Conclusions This study suggests that there are no signiicant diferences in clinical outcome scores or survivorship from TKA between patella alta and non-patella alta patients who underwent onlay design PFA. Both patella alta and non-patella alta patients demonstrated excellent improvement in outcome scores from pre-operative to post-operative. Level of evidence IV.

Purpose The purpose of this study was to identify effects of psychosocial and demographic factors on patellofemoral arthroplasty (PFA) outcomes. Methods Patients who underwent PFA by a single surgeon between 2002 and 2013 (min. 2 year follow‐up) were included. Knee Society scores (KSS), UCLA, and Tegner Scores were prospectively collected in a designated arthroplasty registry. Patient records were retrospectively reviewed and univariate and multivariate statistical analyses were performed to assess the effect of psychosocial factors and demographic variables including patient sex, BMI, smoking and medication use, psychiatric history, and employment status on improvement between pre‐ and post‐operative scores. Results Seventy‐four knees in 55 patients (88% female) with a mean age of 51.8 (SD 8.8) and mean follow‐up of 46.5 (SD 26.9) months were included. Patients showed significant improvement in all functional outcomes (p < 0.001). Mean improvement in KSS‐F scores and median improvement in Tegner scores was greater in males compared to females (37.8 vs 16.1, p = 0.007; 3.0 vs 2.0, p = 0.07, respectively). Smokers showed less improvement in KSS‐P compared to non‐smokers (17.2 vs 30.0, p = 0.028). Retired or employed patients had a greater mean improvement in KSS‐F and median improvement in Tegner Scores compared to those were unemployed or on work disability (p = 0.022, p = 0.01). Patients who reported using opioids and/or anti‐depressants pre‐operatively showed less improvement in UCLA scores (p = 0.006). Obese patients showed less improvement in both KSS‐F and Tegner score compared to non‐obese patients (p = 0.009, p = 0.004). Conclusion Psychosocial factors influence the degree of improvement following PFA. Although patients showed overall improvement compared to their baseline scores, obese patients, smokers, unemployed/work disabled, and pre‐operative use of opioids and/or anti‐depressants were risk factors for decreased improvement… The consideration of psychosocial variables are clinically important when assessing a patient's candidacy for PFA and improve pre‐operative patient selection and counselling. Level of evidence Level IV.