Reliable improvements in participation in low-impact sports following implantation of a patellofemoral inlay arthroplasty at mid-term follow-up

Pogorzelski, Jonas; Rupp, Marco-Christopher; Ketzer, Conrad; Cotic, Matthias; Lutz, Patricia M.; Beeck, S.; Imhoff, Andreas B.; Feucht, Matthias J.

doi:10.1007/s00167-020-06245-5

Cited by 15 publications

(13 citation statements)

References 32 publications

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“…Foote et al found that only 54% of patients undergoing PFA with a second-generation implant were able to return to work 80 . Conversely, Pogorzelski et al reported that 94% of patients who did not fail could return to the same or higher level of sports, with 74% reporting an improved ability to perform low-impact sports 81 . This again highlights the importance of expectation management because it seems unlikely that most patients will return to high level or high-impact sports after PFA.…”

Section: Resultsmentioning

confidence: 99%

Modern Patellofemoral Arthroplasty

Bond,

Stauffer,

Hendren

et al. 2023

JBJS Reviews

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Introduction: The ideal procedure for isolated patellofemoral arthritis is a controversial topic. Patellofemoral arthroplasty (PFA) is an option that aims to restore normal kinematics to the knee while preserving bone. PFA has been shown to have benefits compared with total knee arthroplasty (TKA) in this patient population but has historically had a high failure rate. Revision rates are improving with modern implants and tight indications but still remain higher than TKA. This review summarizes current thinking around PFA using modern implants and techniques in 2023, provides an implant-specific analysis, and assesses how we can improve outcomes after PFA based on the current literature. The aim was to provide an outline of the evidence around PFA on which surgeons can make decisions to optimize patient outcome in this young and active population. Methods: Four databases (MEDLINE, Embase, Scopus, and SPORTDiscus) were searched for concepts of patellofemoral joint arthroplasty. After abstract and text review, a screening software was used to assess articles based on inclusion criteria for studies describing indications, outcomes, and techniques for isolated PFA using modern implants, with or without concomitant procedures. Results: A total of 191 articles were included for further examination, with 62 articles being instructional course lectures, systematic reviews, technique articles, narrative reviews, expert opinions, or meta-analyses. The remaining articles were case reports, trials, or cohort studies. Articles were used to create a thorough outline of multiple recurrent topics in the literature. Conclusions: PFA is an appealing option that has the potential to provide a more natural feeling and functioning knee for those with isolated PF arthritis. The high rate of revision is a cause for concern and there are several technical details that should be stressed to optimize results. The uncertain outcome after revision to TKA also requires more investigation. In addition, the importance of strict selection criteria and firm indications cannot be stressed enough to optimize longevity and attempt to predict those who are likely to have progression of tibiofemoral osteoarthritis. The development of new third-generation implants is promising with excellent functional outcomes and a much lower rate of maltracking and implant complications compared with earlier generations. The impact of these implants and improvement in surgical techniques on the revision rate of PFA will be determined from longer-term outcomes.

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Section: Resultsmentioning

confidence: 99%

Modern Patellofemoral Arthroplasty

Bond,

Stauffer,

Hendren

et al. 2023

JBJS Reviews

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“…Another weakness is the retrospective type of the majority of the included studies, which could have led to an unknown selection bias. Another important aspect is that there are no studies reporting at mid-and long-term follow ups regarding the new inlay type of prosthesis, meaning that safe conclusions, with regards to the clinical and functional [38] 16 HemiCap Wave 24.1 (6-34) 1 (6.3%) 0 (0.0%) Metcalfe [32] 558 Avon 180 (nm) 61 (10.9%) 61 (10.9%) Ajnin [2] 43 FPV 65 (30-119) 5 (11.6%) 6 (13.9%) Bohu [10] 30 Hermes 240 (nm) 9 (30.0%) 9 (30.0%) Imhoff [22] 24 HemiCap Wave 60 (nm) 0 (0.0%) 6 (25.0%) Rammohan [42] 103 Journey 60 (± 12, 24-108) 9 (8.7%) 2 (1.9%) Bernard [7] 153 Avon 60 (± 30) 9 (5.9%) 9 (5.9%) Pogorzelski [40] 62 HemiCap Wave 60 (± 25) 12 (19.4%) 12 (19.4%) Marullo [30] 120 Gender Solutions 84 (± 30, 24-142) 5 (4.2%) 1 (0.8%) outcomes, and the survivorship of this type of prosthesis should be drawn with all due caution. Lastly, many authors were consultants for the companies designing the type of prostheses investigated in the respective studies, which might have led to a conflict of interest.…”

Section: Discussionmentioning

confidence: 99%

Patellofemoral arthroplasty with onlay prosthesis leads to higher rates of osteoarthritis progression than inlay design implants: a systematic review

Sava

Neopoulos

Leica

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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Purpose The aim of this study was to report the clinical and functional outcomes, complication rates, implant survivorship and the progression of tibiofemoral osteoarthritis (OA), after new inlay or onlay patellofemoral arthroplasty (PFA), for isolated patellofemoral OA. Comparison of different implant types and models, where it was possible, also represented one of the objectives. Methods A systematic literature search following PRISMA guidelines was conducted on PubMed, Scopus, Embase and Cochrane databases, to identify possible relevant studies, published from the inception of these databases until 11.11.2022. Randomized control trials (RCTs), case series, case control studies and cohort studies, written in English or German, and published in peer-reviewed journals after 2010, were included. Not original studies, case reports, simulation studies, systematic reviews, or studies that included patients who underwent TKA or unicompartmental arthroplasty (UKA) of the medial or lateral compartment of the knee, were excluded. Additionally, only articles that assessed functional and/or clinical outcomes, patient-reported outcomes (PROMs), radiographic progression of OA, complication rates, implant survival rates, pain, as well as conversion to TKA rates in patients treated with PFA, using inlay or onlay trochlea designs, were included. For quality assessment, the Methodological Index for Non-Randomized Studies (MINORS) for non-comparative and comparative clinical intervention studies was used. Results The literature search identified 404 articles. 29 of them met all the inclusion criteria following the selection process. Median MINORS for non-comparative studies value was 12.5 (range 11–14), and for comparative studies 20.1 (range 17–24). In terms of clinical and functional outcomes, no difference between onlay and inlay PFA has been described. Both designs yielded satisfactory results at short, medium and long-term follow-ups. Both designs improved pain postoperatively and no difference between them in terms of postoperative VAS has been noted, although the onlay groups presented a higher preoperative VAS. When comparing the inlay to onlay trochlea designs, the inlay group displayed a lower progression of OA rate. Conclusion There is no difference in functional or clinical outcomes after PFA between the new inlay and the onlay designs, with both presenting an improvement in most of the scores that were used. A higher rate of OA progression was observed in the onlay design group. Level of evidence III.

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“…6 Comparison of the Physical Activity Scores between PFA and TKA groups Fig. 7 Forest plot of reporting satisfaction rates for PFA and TKA patients over a 3-to 17-year follow-up [43][44][45][46][47]. For example, Cartier et al [44] reported on a study of the firstgeneration of PFA that 55 of 65 patients achieved good to excellent results at 4 years.…”

Section: Discussionmentioning

confidence: 99%

“…Van der List JP et al [47] found that the 5-, 10-, 15-and 20-year survival rate of PFA prosthesis was 91.7%, 83.3%, 74.9%, and 66.6%, respectively. In addition, in a study of 62 patients with a mean follow-up of 5.0 ± 2.1 years, Jonas Pogorzelski et al [46] demonstrated that 94% of the patients with PFA were able to return to the same or higher level of exercise, while 74% of the patients showed improved ability to perform sports.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Reliable improvements in participation in low-impact sports following implantation of a patellofemoral inlay arthroplasty at mid-term follow-up

Cited by 15 publications

References 32 publications

Modern Patellofemoral Arthroplasty

Modern Patellofemoral Arthroplasty

Patellofemoral arthroplasty with onlay prosthesis leads to higher rates of osteoarthritis progression than inlay design implants: a systematic review

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

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