Does patellofemoral osteoarthritis affect functional outcomes and survivorship after medial unicompartmental knee arthroplasty? A meta-analysis

Abstract

Purpose The argument that patellofemoral osteoarthritis (PFOA) is a contraindication to unicompartmental knee arthroplasty (UKA) remains to be resolved. The purpose of this study was to perform a meta-analysis to determine whether PFOA affects functional outcomes and survivorship after medial UKA. Methods A literature search was performed in PubMed, Medline, Cochrane Library and Web of science to identify studies published in English (the last search was updated on June 1, 2020). The primary outcome measure was the Oxford Knee Score (OKS), whereas the secondary outcomes included range of motion (ROM) and the revision rate. Patients with patellofemoral joint narrowing or cartilage lesions as assessed intraoperatively or by radiography were assigned to the PFOA group. Results A total of 8 studies involving 3504 patients and 3975 knees were included in this meta-analysis. No patients had a severe lateral patellar groove. The results showed that there was no significant difference in the OKS, revision rate and ROM between PFOA patients and patients without PFOA. Conclusions No significant difference in functional outcomes and survivorship was found between patients with and without PFOA. Patients with PFOA assessed by radiographs or intraoperatively but without a lateral patellar groove should be considered candidates for medial UKA.

Unicompartmental knee replacement: controversies and technical considerations

“…The impact of such coexistence has been explored in multiple research projects. Lu et al [ 124 ], Deckard et al [ 125 ], and Ercan et al [ 126 ] concluded that whether coexisting OA is present does not significantly affect the outcome. Burger et al [ 127 ] concluded that mild to moderate preoperative radiological degenerative changes, and mal-alignment of the PF joint are not associated with unfavorable outcomes.…”

Incidence and severity of radiological lateral osteoarthritis 15 years following medial unicompartmental knee arthroplasty

“…This study found no statistically significant relationship between intraoperative of patellofemoral joint findings and severity of JSW L , and therefore agrees with other papers that conclude that the state of the patellofemoral joint should not be considered a contraindication in UKA. 31 - 33 …”

“…This study found no statistically significant relationship between intraoperative of patellofemoral joint findings and severity of JSW L , and therefore agrees with other papers that conclude that the state of the patellofemoral joint should not be considered a contraindication in UKA. [31][32][33] The main limitation of the study was that some of the unrevised UKAs implanted 15 years ago or more did not have radiographs at 15 years. Therefore, the sample may not be representative of the whole cohort and may underestimate the incidence of lateral OA.…”

Better immediate and early postoperative outcomes of unicompartmental knee replacement comparing with total knee replacement: A matched cohort of patients with medial knee osteoarthritis

“…Over the past two decades, there had been debates on whether patellofemoral joint degeneration affects the outcome of unicompartmental knee replacement. 13,14 In our study, we attempted to minimize the influence of patellofemoral joint degeneration when comparing the outcomes between UKR and TKR groups. Hence, we matched the two groups of patients both radiologically and functionally.…”