J P van der List1, H Chawla2, J C Villa3, A D Pearle4. 1. Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA. Electronic address: vanderlistj@hss.edu. 2. Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA. Electronic address: chawlah@hss.edu. 3. Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA. Electronic address: villaj@hss.edu. 4. Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA. Electronic address: pearlea@hss.edu.
Abstract
BACKGROUND: Historically poor results of patellofemoral arthroplasty (PFA) were reported in the setting of isolated patellofemoral osteoarthritis (OA). In order to lower PFA failure rates, it is important to identify failure modes using a standardized method. In this systematic review, PFA failure modes were assessed and compared in early vs. late failures and older vs. recent studies. METHODS: Databases of PubMed, Embase and Cochrane and annual registries were searched for studies reporting PFA failures. Failure modes in studies with mean follow-up <5years were classified as early failures while >5years were classified late failures. Cohorts started before 2000 were classified as older studies and started after 2000 as recent studies. RESULTS: Thirty-nine cohort studies (10 level II and 29 level III or IV studies) and three registries were included with overall low quality of studies (GRADE criteria). A total of 938 PFA failures were included and were caused by OA progression (38%), pain (16%), aseptic loosening (14%) and patellar maltracking (10%). Pain was responsible for most early failures (31%), while OA progression was most common in late failures (46%). In older studies, OA progression was more commonly reported as failure mode than in more recent studies (53% vs. 39%, p=0.005). CONCLUSION: This level IV systematic review with low quality of studies identified OA progression and pain as major failure modes. Reviewing these studies, appropriate patient selection could prevent PFA failures in select cases. Future studies assessing the role of PFA in isolated patellofemoral OA are necessary.
BACKGROUND: Historically poor results of patellofemoral arthroplasty (PFA) were reported in the setting of isolated patellofemoral osteoarthritis (OA). In order to lower PFA failure rates, it is important to identify failure modes using a standardized method. In this systematic review, PFA failure modes were assessed and compared in early vs. late failures and older vs. recent studies. METHODS: Databases of PubMed, Embase and Cochrane and annual registries were searched for studies reporting PFA failures. Failure modes in studies with mean follow-up <5years were classified as early failures while >5years were classified late failures. Cohorts started before 2000 were classified as older studies and started after 2000 as recent studies. RESULTS: Thirty-nine cohort studies (10 level II and 29 level III or IV studies) and three registries were included with overall low quality of studies (GRADE criteria). A total of 938 PFA failures were included and were caused by OA progression (38%), pain (16%), aseptic loosening (14%) and patellar maltracking (10%). Pain was responsible for most early failures (31%), while OA progression was most common in late failures (46%). In older studies, OA progression was more commonly reported as failure mode than in more recent studies (53% vs. 39%, p=0.005). CONCLUSION: This level IV systematic review with low quality of studies identified OA progression and pain as major failure modes. Reviewing these studies, appropriate patient selection could prevent PFA failures in select cases. Future studies assessing the role of PFA in isolated patellofemoral OA are necessary.
Authors: Anders Odgaard; Andreas Kappel; Frank Madsen; Per Wagner Kristensen; Snorre Stephensen; Amir Pasha Attarzadeh Journal: Clin Orthop Relat Res Date: 2022-03-21 Impact factor: 4.755