Patellofemoral arthroplasty versus total knee arthroplasty for isolated patellofemoral osteoarthritis: a systematic review and meta-analysis

Abstract

Background Isolated patellofemoral osteoarthritis (PF-OA) is a common subtype of knee osteoarthritis, leading to a huge economic burden on health care systems. Although previous studies have shown that patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA) have good clinical effects, it remains largely unclear which treatment is more effective for patients with isolated PF-OA. We aimed to compare postoperative function, complications, revision rates, level of physical activity, and satisfaction rate between the two surgical techniques. Methods Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Search of literature was conducted in MEDLINE, EMBASE, Cochrane Library, and Web of Science until November 2020. The included studies were those that provided direct comparison of postoperative outcomes between PFA and TKA. Data were extracted from eligible studies and combined to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). Sensitivity analysis and subgroup analysis were conducted to evaluate heterogeneity between the two groups. Results A total of 7 eligible studies (3 recent randomized controlled trials and 4 nonrandomized controlled trials) were included in this meta-analysis. The pooled results showed that both the PFA group and the TKA group had improved postoperative indicators, suggesting that the two operation modes could improve the knee function and quality of life of patients. Throughout the first 2 years postoperatively, higher activity level, and better functional recovery were observed for PFA compared with TKA in this study; moreover, the differences between the two operation modes were statistically significant (p < 0.05). We found no significant difference in complications, revision rates, and satisfaction rate between the two procedures. Conclusion Although there was no observed difference in the complications, revision rates, and satisfaction rate between PFA and TKA, PFA was superior to TKA in terms of knee function and physical activity in the first 2 years postoperatively. Therefore, PFA is a safe, effective, and less invasive treatment for patients with isolated PF-OA. Our findings are consistent with the systematic review of current evidence that PFA may be more suitable for younger patients with high activity needs. Patient selection is, therefore, thought to be of paramount importance. Individualized surgical plan should be designed according to the patient’s age, BMI, KOA site, and activity level and combined with the doctor’s personal experience.

The impact of primary patella resurfacing on health-related quality of life outcomes and return to sport in total knee arthroplasty (TKA)

“…Kaseb et al [ 13 ] found 6 months postoperatively no differences in WOMAC Scores, AKP, KSS and pain scores. For isolated patellafemoral OA, Peng et al [ 20 ] examined 7 eligible studies in a systematic review. Functional scores and physical activity were enhanced with patellafemoral replacement instead of TKA [ 20 ].…”

“…For isolated patellafemoral OA, Peng et al [ 20 ] examined 7 eligible studies in a systematic review. Functional scores and physical activity were enhanced with patellafemoral replacement instead of TKA [ 20 ]. Ponzio et al [ 21 ] found 2 years after surgery less improvement for preoperative physically active patients, for TKA patients in general.…”

Patellofemoral arthroplasty: expert opinion

“…A recent systematic review and meta-analysis comparing PFA and TKA by Peng et al, included 3 randomized controlled trials (RCT) [ 15 , 19 , 28 ], of which only two reported clinical outcomes [ 19 , 28 ]. They found that throughout the first 2 years postoperatively, a statistically significant higher activity level, and better functional recovery were observed for PFA compared with TKA [ 29 ]. They do not report whether this statistical difference also translates into to a clinically relevant difference.…”

“…They do not report whether this statistical difference also translates into to a clinically relevant difference. The authors did not find statistically significant differences in complications, revision rates, and satisfaction rates between the two procedures [ 29 ].…”

Emergency Department Visits Following Patellofemoral Arthroplasty

“…5–8 Despite this, newer, second-generation implants are viewed more favorably. 9 PFA with modern implants may enable a shorter time to recovery with similar outcomes, 10 lower revision rates, 11 improved knee-related quality of life, 12 lower cost, 13 and better range of motion at 2 years 12 when compared with total knee arthroplasty (TKA). As such, PFA is becoming an increasingly popular option for the treatment of isolated patellofemoral arthritis.…”