Should we recommend patellofemoral arthroplasties to patients?

Martinique Vella-Baldacchino; Jeremy Webb; Bhavana Selvarajah; Sukhjaad Chatha; Andrew Davies; Justin P Cobb; Alexander D Liddle

doi:10.1302/2633-1462.412.BJO-2023-0100.R1

Should we recommend patellofemoral arthroplasties to patients?

Bone Jt Open. 2023 Dec 15;4(12):948-956. doi: 10.1302/2633-1462.412.BJO-2023-0100.R1.

Authors

Martinique Vella-Baldacchino¹, Jeremy Webb², Bhavana Selvarajah², Sukhjaad Chatha², Andrew Davies³, Justin P Cobb¹, Alexander D Liddle¹

Affiliations

¹ MSk Lab, Imperial College London, Department of Surgery & Cancer, Sir Michael Uren Hub, London, UK.
² Lister Hospital, Stevenage, UK.
³ Department of Bioengineering, Imperial College London, London, UK.

PMID: 38096897
PMCID: PMC10721344
DOI: 10.1302/2633-1462.412.BJO-2023-0100.R1

Abstract

Aims: With up to 40% of patients having patellofemoral joint osteoarthritis (PFJ OA), the two arthroplasty options are to replace solely the patellofemoral joint via patellofemoral arthroplasty (PFA), or the entire knee via total knee arthroplasty (TKA). The aim of this study was to assess postoperative success of second-generation PFAs compared to TKAs for patients treated for PFJ OA using patient-reported outcome measures (PROMs) and domains deemed important by patients following a patient and public involvement meeting.

Methods: MEDLINE, EMBASE via OVID, CINAHL, and EBSCO were searched from inception to January 2022. Any study addressing surgical treatment of primary patellofemoral joint OA using second generation PFA and TKA in patients aged above 18 years with follow-up data of 30 days were included. Studies relating to OA secondary to trauma were excluded. ROB-2 and ROBINS-I bias tools were used.

Results: A total of nine studies were included, made up of four randomized controlled trials (domain 1) and five cohort studies (domain 2). PROMs and knee function specific scores developed for reporting TKA were unable to detect any difference between PFA and TKA. There was no significant difference in complications between PFA and TKA. PFAs were found to have a better postoperative range of motion.

Conclusion: TKA and PFA are both viable options for patients with primary PFJ OA. Over time, we have seen an emphasis on patient satisfaction and better quality of life. Recommending sacrificing healthy medial and lateral compartments to treat patellofemoral joint arthritis should be given further thought.