J Knee Surg 2023; 36(04): 382-388
DOI: 10.1055/s-0041-1735159
Original Article

Patient-Reported Outcomes and Risk Factors for Decreased Improvement after Patellofemoral Arthroplasty

Yike Dai
1   Department of Orthopaedic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
,
Naicheng Diao
1   Department of Orthopaedic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
,
Wei Lin
2   Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
,
Guangmin Yang
2   Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
,
Huijun Kang
2   Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
,
Fei Wang
2   Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
› Author Affiliations

Abstract

Patellofemoral arthroplasty (PFA) is acknowledged as the method for the treatment of isolated patellofemoral osteoarthritis (PFOA). Few previous studies have assessed the patient-reported outcomes (PROs) and risk factors of less improvement of PROs in patients undergoing PFA. A retrospective analysis was performed, including all patients who had undergone PFA. Pre- and postoperative PROs included the Oxford Knee Score (OKS) and Kujala score. Univariate and multivariate statistical analyses were performed to assess influencing factors of less improvement of PROs including the demographic factors (gender, age, body mass index, smoking, opioid usage, and duration of symptoms [DOSs]), surgical factors (concomitant surgery), and imaging factors (trochlear dysplasia [TD], patellar height, the degree of PFOA). A total of 46 PFAs were analyzed with a mean follow-up of 37 ± 7 months. The mean age at surgery was 61.1 ± 7.7 years. Patients showed significant improvement in all PROs (p < 0.001). Patients with TD preoperatively have greater improvement in OKS and Kujala score postoperatively (19.2 ± 5.0 vs. 23.1 ± 3.6, p = 0.038). Longer DOSs (≥1 year) had a greater mean improvement in OKS and Kujala score (p = 0.011 and p = 0.000). According to the measurement of patella height, patients with patella alta (Caton–Deschamps index [CDI] ≥1.3) showed less improvement in both OKS and Kujala score (p = 0.000 and p = 0.002). PFA is a safe and efficient surgery with good PROs. Patella alta with a CDI ≥1.3 and duration of preoperative symptoms ≤ 1 year were risk factors for decreased OKS and Kujala score improvement, while the preoperative presence of TD was significantly predictive factors for increased OKS improvement.



Publication History

Received: 08 January 2021

Accepted: 22 July 2021

Article published online:
28 September 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Davies AP, Vince AS, Shepstone L, Donell ST, Glasgow MM. The radiologic prevalence of patellofemoral osteoarthritis. Clin Orthop Relat Res 2002; (402) 206-212
  • 2 McAlindon TE, Snow S, Cooper C, Dieppe PA. Radiographic patterns of osteoarthritis of the knee joint in the community: the importance of the patellofemoral joint. Ann Rheum Dis 1992; 51 (07) 844-849
  • 3 Pisanu G, Rosso F, Bertolo C. et al. Patellofemoral arthroplasty: current concepts and review of the literature. Joints 2017; 5 (04) 237-245
  • 4 Tauro B, Ackroyd CE, Newman JH, Shah NA. The Lubinus patellofemoral arthroplasty. A five- to ten-year prospective study. J Bone Joint Surg Br 2001; 83 (05) 696-701
  • 5 Tarassoli P, Punwar S, Khan W, Johnstone D. Patellofemoral arthroplasty: a systematic review of the literature. Open Orthop J 2012; 6: 340-347
  • 6 Odumenya M, Costa ML, Parsons N, Achten J, Dhillon M, Krikler SJ. The Avon patellofemoral joint replacement: five-year results from an independent centre. J Bone Joint Surg Br 2010; 92 (01) 56-60
  • 7 Osarumwense D, Syed F, Nzeako O, Akilapa S, Zubair O, Waite J. Patellofemoral joint arthroplasty: early results and functional outcome of the Zimmer Gender Solutions Patello-Femoral Joint System. Clin Orthop Surg 2017; 9 (03) 295-302
  • 8 Morris MJ, Lombardi Jr AV, Berend KR, Hurst JM, Adams JB. Clinical results of patellofemoral arthroplasty. J Arthroplasty 2013; 28 (9, Suppl): 199-201
  • 9 Wylde V, Blom AW, Whitehouse SL, Taylor AH, Pattison GT, Bannister GC. Patient-reported outcomes after total hip and knee arthroplasty: comparison of midterm results. J Arthroplasty 2009; 24 (02) 210-216
  • 10 Anakwe RE, Jenkins PJ, Moran M. Predicting dissatisfaction after total hip arthroplasty: a study of 850 patients. J Arthroplasty 2011; 26 (02) 209-213
  • 11 Scott CE, Howie CR, MacDonald D, Biant LC. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 2010; 92 (09) 1253-1258
  • 12 Mont MA, Johnson AJ, Naziri Q, Kolisek FR, Leadbetter WB. Patellofemoral arthroplasty: 7-year mean follow-up. J Arthroplasty 2012; 27 (03) 358-361
  • 13 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
  • 14 Liow MH, Goh GS, Tay DK, Chia SL, Lo NN, Yeo SJ. Obesity and the absence of trochlear dysplasia increase the risk of revision in patellofemoral arthroplasty. Knee 2016; 23 (02) 331-337
  • 15 Desai VS, Pareek A, DeDeugd CM. et al. Smoking, unemployment, female sex, obesity, and medication use yield worse outcomes in patellofemoral arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28 (09) 2962-2969
  • 16 Leadbetter WB, Ragland PS, Mont MA. The appropriate use of patellofemoral arthroplasty: an analysis of reported indications, contraindications, and failures. Clin Orthop Relat Res 2005; (436) 91-99
  • 17 Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 1998; 80 (01) 63-69
  • 18 Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy 1993; 9 (02) 159-163
  • 19 Dejour D, Saggin P. The sulcus deepening trochleoplasty-the Lyon's procedure. Int Orthop 2010; 34 (02) 311-316
  • 20 Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. Les rotules basses (Patellae inferae) – A propos de 128 observations. Rev Chir Orthop 1982; 68 (05) 317-325
  • 21 Iwano T, Kurosawa H, Tokuyama H, Hoshikawa Y. Roentgenographic and clinical findings of patellofemoral osteoarthrosis. With special reference to its relationship to femorotibial osteoarthrosis and etiologic factors. Clin Orthop Relat Res 1990; (252) 190-197
  • 22 Muneta T, Yamamoto H, Ishibashi T, Asahina S, Furuya K. Computerized tomographic analysis of tibial tubercle position in the painful female patellofemoral joint. Am J Sports Med 1994; 22 (01) 67-71
  • 23 Perrone FL, Baron S, Suero EM. et al. Patient-reported outcome measures (PROMs) in patients undergoing patellofemoral arthroplasty and total knee replacement: a comparative study. Technol Health Care 2018; 26 (03) 507-514
  • 24 Bunyoz KI, Lustig S, Troelsen A. Similar postoperative patient-reported outcome in both second generation patellofemoral arthroplasty and total knee arthroplasty for treatment of isolated patellofemoral osteoarthritis: a systematic review. Knee Surg Sports Traumatol Arthrosc 2019; 27 (07) 2226-2237
  • 25 Odgaard A, Madsen F, Kristensen PW, Kappel A, Fabrin J. The mark Coventry award: patellofemoral arthroplasty results in better range of movement and early patient-reported outcomes than TKA. Clin Orthop Relat Res 2018; 476 (01) 87-100
  • 26 Sillanpää PJ, Mäenpää HM, Mattila VM, Visuri T, Pihlajamäki H. Arthroscopic surgery for primary traumatic patellar dislocation: a prospective, nonrandomized study comparing patients treated with and without acute arthroscopic stabilization with a median 7-year follow-up. Am J Sports Med 2008; 36 (12) 2301-2309
  • 27 Gibon E, Goodman MJ, Goodman SB. Patient satisfaction after total knee arthroplasty a realistic or imaginary goal?. Orthop Clin North Am 2017; 48 (04) 421-431
  • 28 Rezzadeh K, Behery OA, Kester BS, Dogra T, Vigdorchik J, Schwarzkopf R. Patellofemoral arthroplasty: short-term complications and risk factors. J Knee Surg 2020; 33 (09) 912-918
  • 29 Ollivier M, Frey S, Parratte S, Flecher X, Argenson JN. Pre-operative function, motivation and duration of symptoms predict sporting participation after total hip replacement. Bone Joint J 2014; 96-B (08) 1041-1046
  • 30 Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 2000; 71 (03) 262-267
  • 31 Dunbar MJ, Richardson G, Robertsson O. I can't get no satisfaction after my total knee replacement: rhymes and reasons. Bone Joint J 2013; 95-B (11, Suppl A): 148-152
  • 32 Hamilton DF, Lane JV, Gaston P. et al. What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement. BMJ Open 2013; 3 (04) e002525
  • 33 Kannus PA. Long patellar tendon: radiographic sign of patellofemoral pain syndrome–a prospective study. Radiology 1992; 185 (03) 859-863
  • 34 Luyckx T, Didden K, Vandenneucker H, Labey L, Innocenti B, Bellemans J. Is there a biomechanical explanation for anterior knee pain in patients with patella alta? Influence of patellar height on patellofemoral contact force, contact area and contact pressure. J Bone Joint Surg Br 2009; 91 (03) 344-350
  • 35 Ward SR, Terk MR, Powers CM. Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing. J Bone Joint Surg Am 2007; 89 (08) 1749-1755
  • 36 Caton J, Mironneau A, Walch G, Levigne C, Michel CR. La rotule haute idiopathique chez l'adolescent. A propos de 61 cas opérés. Rev Chir Orthop Repar Appar Mot 1990; 76 (04) 253-260
  • 37 Dejour H, Walch G, Neyret P, Adeleine P. La dysplasie de la trochlée fémorale. Rev Chir Orthop Repar Appar Mot 1990; 76 (01) 45-54
  • 38 Stefanik JJ, Zhu Y, Zumwalt AC. et al. Association between patella alta and the prevalence and worsening of structural features of patellofemoral joint osteoarthritis: the multicenter osteoarthritis study. Arthritis Care Res (Hoboken) 2010; 62 (09) 1258-1265
  • 39 Ward SR, Powers CM. The influence of patella alta on patellofemoral joint stress during normal and fast walking. Clin Biomech (Bristol, Avon) 2004; 19 (10) 1040-1047
  • 40 Singerman R, Davy DT, Goldberg VM. Effects of patella alta and patella infera on patellofemoral contact forces. J Biomech 1994; 27 (08) 1059-1065
  • 41 Rogers BA. Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing. J Bone Joint Surg Am 2008; 90 (02) 446-447 , author reply 447
  • 42 Hinman RS, Lentzos J, Vicenzino B, Crossley KM. Is patellofemoral osteoarthritis common in middle-aged people with chronic patellofemoral pain?. Arthritis Care Res (Hoboken) 2014; 66 (08) 1252-1257
  • 43 McWilliams TG, Binns MS. A locked knee in extension: a complication of a degenerate knee with patella alta. J Bone Joint Surg Br 2000; 82 (06) 890
  • 44 Caton JH, Dejour D. Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop 2010; 34 (02) 305-309
  • 45 Magnussen RA. Patella alta sees you, do you see it?. Am J Orthop (Belle Mead NJ) 2017; 46 (05) 229-231
  • 46 Sappey-Marinier E, Sonnery-Cottet B, O'Loughlin P. et al. Clinical outcomes and predictive factors for failure with isolated MPFL reconstruction for recurrent patellar instability: a series of 211 reconstructions with a minimum follow-up of 3 years. Am J Sports Med 2019; 47 (06) 1323-1330
  • 47 Zhang GY, Ding HY, Li EM. et al. Incidence of second-time lateral patellar dislocation is associated with anatomic factors, age and injury patterns of medial patellofemoral ligament in first-time lateral patellar dislocation: a prospective magnetic resonance imaging study with 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 2019; 27 (01) 197-205
  • 48 Marco Valoroso, Mo Saffarini, Giuseppe La Barbera, Cécile Toanen, Gerjon Hannink, Luca Nover, David H Dejour. Correction of patellofemoral Malalignment With Patellofemoral Arthroplasty. J Arthroplasty 2017; 32 (12) 3598-3602
  • 49 Argenson JN, Flecher X, Parratte S, Aubaniac JM. Patellofemoral arthroplasty: an update. Clin Orthop Relat Res 2005; 440 (440) 50-53
  • 50 Diane LDahm, Michael MKalisvaart, Michael JStuart, Seth WSlettedahl. Patellofemoral arthroplasty: outcomes and factors associated with early progression of tibiofemoral arthritis. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2554-2559
  • 51 Nicol SG, Loveridge JM, Weale AE, Ackroyd CE, Newman JH. Arthritis progression after patellofemoral joint replacement. Knee 2006; 13 (04) 290-295