PATELLOFEMORAL ARTHROPLASTY – RESULTS OF A NATIONWIDE SURVEY IN GERMANY

Abstract

Background: Isolated patellofemoral arthroplasty has gained new attention after recently published positive results. It is considered an intermediate treatment for the patient with isolated arthritis of the anterior compartment of the knee. Aim of this nationwide survey was to determine the current status of patellofemoral arthroplasty in Germany.

Methods: All German departments of orthopaedic surgery, traumatology and general surgery with a yearly performance of at least fifty knee arthroplasties were asked to complete a standardized questionnaire. In the first part, surgeons were asked general questions about their department size, case numbers of knee arthroplasties per year and non-endoprosthetic treatment of isolated patellofemoral disorders. If patellofemoral arthroplasty was conducted, parameters concerning age, gender, duration of complaints, indication for surgery, surgical approach, type of endoprosthesis used, additional surgical treatments and failures were evaluated in the second part. Furthermore we asked for the reasons if no isolated patellofemoral arthroplasty was performed.

Results: A total of 224 (30%) usable questionnaires were returned. Of 53420 knee arthroplasties performed per year, only 195 were isolated patellofemoral arthroplaties (0.37%). However, in 54 departments (24%), at least one isolated patellofemoral arthroplasty was performed with an average of 3.95 (1–20) procedures per year. The majority of patients were between 40 and 60 years old (40–60y: 56%; 20–40y: 8%, 60–80y: 35%, > 80y: 1%). Females were affected in 65% of patients. Etiology of isolated patellofemoral arthritis was believed to be idiopathic in 41% and traumatic in 8%. Patellofemoral dysplasia was held responsible in 47% and patellofemoral instability in 4% of cases. The main reason for failure and surgical revision was ongoing pain of the affected knee (40%). Negative attitude and disbelief towards the success of isolated patellofemoral arthroplasty were stated by the majority (62%) of non-users. A lack of appropriate indications was reported by 22% and missing know-how by 16%.

Conclusions: Isolated patellofemoral arthroplasty has only little significance among surgeons performing knee arthroplasty in Germany. Although promising results were reported in the literature, the majority of surgeons do not believe in the success of the procedure.