PDF herunterladen
J Knee Surg 2020; 33(09): 912-918
DOI: 10.1055/s-0039-1688960
Original Article

Patellofemoral Arthroplasty: Short-Term Complications and Risk Factors

Kevin Rezzadeh
1   Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
,
Omar A. Behery
1   Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
,
Benjamin S. Kester
1   Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
,
Tara Dogra
1   Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
,
Jonathon Vigdorchik
1   Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
,
Ran Schwarzkopf
1   Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
› Institutsangaben
› Weitere Informationen
    Lizenzen und Reprints

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.

Keywords

patellofemoral arthroplasty - 30-day complication - patellofemoral joint arthritis - risk factors - NSQIP


Publikationsverlauf

Eingereicht: 23. August 2018

Angenommen: 05. April 2019

Artikel online veröffentlicht:
23. Mai 2019

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Song EK, Park JK, Park CH, Kim MC, Agrawal PR, Seon JK. No difference in anterior knee pain after medial unicompartmental knee arthroplasty in patients with or without patellofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016; 24 (01) 208-213
    CrossrefPubMedGoogle Scholar
  • 2 Lankhorst NE, Damen J, Oei EH. , et al. Incidence, prevalence, natural course and prognosis of patellofemoral osteoarthritis: the Cohort Hip and Cohort Knee study. Osteoarthritis Cartilage 2017; 25 (05) 647-653
    CrossrefPubMedGoogle Scholar
  • 3 Lonner JH. Patellofemoral arthroplasty: pros, cons, and design considerations. Clin Orthop Relat Res 2004; (428) 158-165
    CrossrefPubMedGoogle Scholar
  • 4 Ahearn N, Metcalfe AJ, Hassaballa MA. , et al. The Journey patellofemoral joint arthroplasty: a minimum 5 year follow-up study. Knee 2016; 23 (05) 900-904
    CrossrefPubMedGoogle Scholar
  • 5 Lonner JH. Patellofemoral arthroplasty: an evolving science. Instr Course Lect 2017; 66: 211-221
    PubMedGoogle Scholar
  • 6 Kooijman HJ, Driessen AP, van Horn JR. Long-term results of patellofemoral arthroplasty. A report of 56 arthroplasties with 17 years of follow-up. J Bone Joint Surg Br 2003; 85 (06) 836-840
    CrossrefPubMedGoogle Scholar
  • 7 Blazina ME, Fox JM, Del Pizzo W, Broukhim B, Ivey FM. Patellofemoral replacement. Clin Orthop Relat Res 1979; (144) 98-102
    PubMedGoogle Scholar
  • 8 Cartier P, Sanouiller JL, Grelsamer R. Patellofemoral arthroplasty. 2-12-year follow-up study. J Arthroplasty 1990; 5 (01) 49-55
    CrossrefPubMedGoogle Scholar
  • 9 Arciero RA, Toomey HE. Patellofemoral arthroplasty. A three- to nine-year follow-up study. Clin Orthop Relat Res 1988; (236) 60-71
    PubMedGoogle Scholar
  • 10 Krajca-Radcliffe JB, Coker TP. Patellofemoral arthroplasty. A 2- to 18-year followup study. Clin Orthop Relat Res 1996; (330) 143-151
    PubMedGoogle Scholar
  • 11 de Winter WE, Feith R, van Loon CJ. The Richards type II patellofemoral arthroplasty: 26 cases followed for 1-20 years. Acta Orthop Scand 2001; 72 (05) 487-490
    CrossrefPubMedGoogle Scholar
  • 12 Coleridge S. The Lubinus patellofemoral arthroplasty: a five- to ten-year prospective study. J Bone Joint Surg Br 2002; 84 (02) 306 , author reply 306–307
    CrossrefPubMedGoogle Scholar
  • 13 Lonner JH. Patellofemoral arthroplasty. J Am Acad Orthop Surg 2007; 15 (08) 495-506
    CrossrefPubMedGoogle Scholar
  • 14 Hall BL, Hamilton BH, Richards K, Bilimoria KY, Cohen ME, Ko CY. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg 2009; 250 (03) 363-376
    CrossrefPubMedGoogle Scholar
  • 15 Joynt KE, Orav EJ, Jha AK. Thirty-day readmission rates for Medicare beneficiaries by race and site of care. JAMA 2011; 305 (07) 675-681
    CrossrefPubMedGoogle Scholar
  • 16 Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009; 360 (14) 1418-1428
    CrossrefPubMedGoogle Scholar
  • 17 Kocher RP, Adashi EY. Hospital readmissions and the Affordable Care Act: paying for coordinated quality care. JAMA 2011; 306 (16) 1794-1795
    CrossrefPubMedGoogle Scholar
  • 18 McIlvennan CK, Eapen ZJ, Allen LA. Hospital readmissions reduction program. Circulation 2015; 131 (20) 1796-1803
    CrossrefPubMedGoogle Scholar
  • 19 Healy WL, Wasilewski SA, Takei R, Oberlander M. Patellofemoral complications following total knee arthroplasty. Correlation with implant design and patient risk factors. J Arthroplasty 1995; 10 (02) 197-201
    CrossrefPubMedGoogle Scholar
  • 20 Lustig S, Magnussen RA, Dahm DL, Parker D. Patellofemoral arthroplasty, where are we today?. Knee Surg Sports Traumatol Arthrosc 2012; 20 (07) 1216-1226
    CrossrefPubMedGoogle Scholar
  • 21 Courtney J, Liebelt D, Nett MP, Cushner FD. Blood loss and transfusion rates following patellofemoral arthroplasty. Orthop Clin North Am 2012; 43 (05) e44-e47
    CrossrefPubMedGoogle Scholar
  • 22 Leadbetter WB, Kolisek FR, Levitt RL. , et al. Patellofemoral arthroplasty: a multi-centre study with minimum 2-year follow-up. Int Orthop 2009; 33 (06) 1597-1601
    CrossrefPubMedGoogle Scholar
  • 23 Davies AP. High early revision rate with the FPV patello-femoral unicompartmental arthroplasty. Knee 2013; 20 (06) 482-484
    CrossrefPubMedGoogle Scholar
  • 24 Charalambous CP, Abiddin Z, Mills SP, Rogers S, Sutton P, Parkinson R. The low contact stress patellofemoral replacement: high early failure rate. J Bone Joint Surg Br 2011; 93 (04) 484-489
    CrossrefPubMedGoogle Scholar
  • 25 Lustig S. Patellofemoral arthroplasty. Orthop Traumatol Surg Res 2014; 100 (1, Suppl): S35-S43
    CrossrefPubMedGoogle Scholar
  • 26 Dy CJ, Franco N, Ma Y, Mazumdar M, McCarthy MM, Gonzalez Della Valle A. Complications after patello-femoral versus total knee replacement in the treatment of isolated patello-femoral osteoarthritis. A meta-analysis. Knee Surg Sports Traumatol Arthrosc 2012; 20 (11) 2174-2190
    CrossrefPubMedGoogle Scholar
  • 27 Starks I, Roberts S, White SH. The Avon patellofemoral joint replacement: independent assessment of early functional outcomes. J Bone Joint Surg Br 2009; 91 (12) 1579-1582
    CrossrefPubMedGoogle Scholar
  • 28 Beitzel K, Schöttle PB, Cotic M, Dharmesh V, Imhoff AB. Prospective clinical and radiological two-year results after patellofemoral arthroplasty using an implant with an asymmetric trochlea design. Surg Sports Traumatol Arthrosc 2013; 21 (02) 332-339
    CrossrefPubMedGoogle Scholar
  • 29 van der List JP, Chawla H, Villa JC, Pearle AD. Why do patellofemoral arthroplasties fail today? A systematic review. Knee 2017; 24 (01) 2-8
    CrossrefPubMedGoogle Scholar
  • 30 Pugely AJ, Callaghan JJ, Martin CT, Cram P, Gao Y. Incidence of and risk factors for 30-day readmission following elective primary total joint arthroplasty: analysis from the ACS-NSQIP. J Arthroplasty 2013; 28 (09) 1499-1504
    CrossrefPubMedGoogle Scholar
  • 31 Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 2008; 79 (02) 168-173
    CrossrefPubMedGoogle Scholar
  • 32 Sanna M, Sanna C, Caputo F, Piu G, Salvi M. Surgical approaches in total knee arthroplasty. Joints 2013; 1 (02) 34-44
    PubMedGoogle Scholar
  • 33 van Jonbergen HP, Werkman DM, Barnaart LF, van Kampen A. Long-term outcomes of patellofemoral arthroplasty. J Arthroplasty 2010; 25 (07) 1066-1071
    CrossrefPubMedGoogle Scholar
  • 34 Hutt J, Dodd MB, Bourke H, Bell J. Outcomes of total knee replacement after patellofemoral arthroplasty. J Knee Surg 2013; 26: 219-223
    PubMedGoogle Scholar
  • 35 Rodríguez-Merchán EC, Oussedik S. The arthritic knee: etiology and patterns of disease. In: Rodríguez-Merchán EC, Oussedik S. , eds. Total Knee Arthroplasty. Cham, Switzerland: Springer; 2015
    Google Scholar
  • 36 Bowditch MG, Villar RN. Do obese patients bleed more? A prospective study of blood loss at total hip replacement. Ann R Coll Surg Engl 1999; 81 (03) 198-200
    PubMedGoogle Scholar
  • 37 Silverstein MD, Qin H, Mercer SQ, Fong J, Haydar Z. Risk factors for 30-day hospital readmission in patients ≥65 years of age. Proc Bayl Univ Med Cent 2008; 21 (04) 363-372
    CrossrefPubMedGoogle Scholar
  • 38 Kahn S, Joseph L, Abenhaim L, Leclerc JR. Clinical prediction of deep vein thrombosis in patients with leg symptoms. Thromb Haemost 1999; 81 (03) 353-357
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 39 Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis 2016; 41 (01) 3-14
    CrossrefPubMedGoogle Scholar
  • 40 Hunter T, Yoon RS, Hutzler L. , et al. No evidence for race and socioeconomic status as independent predictors of 30-day readmission rates following orthopedic surgery. Am J Med Qual 2015; 30 (05) 484-488
    CrossrefPubMedGoogle Scholar
  • 41 Tsai TC, Orav EJ, Joynt KE. Disparities in surgical 30-day readmission rates for Medicare beneficiaries by race and site of care. Ann Surg 2014; 259 (06) 1086-1090
    CrossrefPubMedGoogle Scholar
  • 42 Hailer NP. Orthopedic registry research - limitations and future perspectives. Acta Orthop 2015; 86 (01) 1-2
    CrossrefPubMedGoogle Scholar
  • 43 Weinreb JH, Yoshida R, Cote MP, O'Sullivan MB, Mazzocca AD. A review of databases used in orthopaedic surgery research and an analysis of database use in Arthroscopy: The Journal of Arthroscopic and Related Surgery . Arthroscopy 2017; 33 (01) 225-231
    CrossrefPubMedGoogle Scholar