Patellofemoral Arthroplasty: Short-Term Complications and Risk Factors

Abstract

There is a paucity of literature regarding the short-term readmission, reoperation, and complication rates of patellofemoral arthroplasty (PFA). The purpose of this study is to determine the incidence and risk factors of 30-day postoperative complications in patients undergoing PFA. A retrospective cohort study of subjects who underwent PFA from 2010 to 2015 was performed using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Perioperative outcomes and 30-day postoperative complications were ascertained, and patient demographics and comorbidities were analyzed using linear and binomial logistic regression analyses to determine risk factors for postoperative complications. Among the 1,069 patients identified in the NSQIP database, there was a 30-day readmission rate of 4.3% and a 30-day reoperation rate of 1.5%. The leading complications identified were bleeding requiring transfusion (11.7%), urinary tract infection (0.8%), and deep vein thrombosis (DVT) (0.8%). Younger age was a risk factor for superficial wound infection (p = 0.012). Older age was a significant risk factor for longer hospital stays, readmission, bleeding requiring transfusion, urinary tract infection, and pneumonia (p < 0.05 for all). Male sex was a risk factor for longer operation time and DVT (p = 0.001 and p = 0.017, respectively), while female sex was associated with greater incidence of bleeding requiring transfusion (p = 0.049). Elevated body mass index (BMI) was a risk factor for longer hospital stays, greater total operation time, and bleeding requiring transfusion (p < 0.001, p < 0.001, and p = 0.001, respectively). Nonwhite race was a significant risk factor for readmission (p = 0.008). This represents the largest study on early readmissions and the associated risk factors after PFA. PFA 30-day readmission and reoperation rates were <5%. Older age and elevated BMI were both identified as risk factors for adverse perioperative outcomes, including longer operation times, longer hospital stays, and bleeding requiring transfusion.

Recommendations from the ICM-VTE: General

“…Another one of these studies demonstrated no significant correlation between race and post-operative VTE and only included elective pediatric orthopaedic procedures, thus the generalizability of these results to older populations is questionable 116 . One study examining short-term complications following patellofemoral arthroplasty had similar findings, however the time course chosen excludes any potential VTE events that could have occurred beyond thirty days 117 . Furthermore, a retrospective study conducted at a Level 1 trauma center found no difference in outcomes with respect to race for operatively treated tibia fractures 118 .…”

“…However, this is not a universal finding. A few studies have found no significant correlation between post-operative VTE and race [115][116][117][118][119] . Blum et al, found no association between VTE and African American race in analysis of a regional database 115 .…”

A Newly Identified Complication of Patellofemoral Arthroplasty: Case Report and Literature Review

“…Intraoperative, perioperative and postoperative complications were reported in each of the 20 articles 7 , 13 - 27 ( Table 2 ). From these, the researchers identified four articles that described patients affected by traumatic and periprosthetic fractures ( Table 3 ).…”

“…Moreover, bleeding is also responsible for a high percentage of revision surgeries (11.7%) within 30 days. 13 …”

Case Report: Three-dimensional printed prosthesis reconstruction for patello-femoral large osteochondral defects in a patient with distal femoral giant cell tumour: A case report

“…Patello-femoral arthroplasty is commonly used for symptomatic patello-femoral osteoarthritis or isolated osteochondral lesions without ligament instability ( Cotic et al, 2017 ; Jeong et al, 2020 ; Rezzadeh et al, 2020 ). The patient suffered from patello-femoral large osteochondral defects in our case, but patello-femoral arthroplasty could not achieve mechanical stability because of mass bone defects.…”