Abstract
Introduction
The optimal treatment for isolated patello-femoral arthritis is unclear. Patello-femoral arthroplasty (PFA) may offer superior knee function in isolated patello-femoral osteoarthritis compare to TKA. The literature is controversial for patient outcomes in PFA. Some reports showed improved outcomes while others were disappointing. We assessed our outcomes to try to identify causes for poor outcomes.
Methods
The Trent Arthroplasty was established in 1990 to collect prospective data on knee arthroplasty surgery. Data is entered by surgeons at the time of surgery, with patient consent. PFA constitute less than 1% of the arthroplasties performed in this region. Patients were sent self-administered outcome forms 1 year post-op. Re-operation and revision procedures were reported. 334 PFA have been registered from 17 hospitals. 79% were female patients with 43% of the patients aged 55 years or less, suggesting dysplasia as the cause of their osteoarthritis. Age range 28–94 yrs (SD 11.8 yrs). The implants were Stryker Avon 236, Corin Leicester 47, Link Lubinus 24, Smith & Nephew Journey 10, DePuy LCS 7, Wright FPV 2, other 8.
Results
18% of patients stated that they were dissatisfied 1 year post-op (7.9% for TKA) and 12% were unsure. Pain was the cause of dissatisfaction in two-thirds of the dis-satisfied patients. Fifty-eight of the 334 implants have been revised, 45 to a TKA. Patellar button was revised in 70% of cases. Revision was due to progression of arthritis in 29, continuing pain in 9, and aseptic loosening of the patella in 7.
Conclusion
Results of patello-femoral arthroplasty appear to be disappointing. This may be due to patient selection or surgery being technically demanding. Given that this surgery is performed infrequently, surgeons should be cautious when considering isolated patello-femoral replacement and should inform the patient of patient reported outcomes. Therefore, non-arthroplasty surgery or a TKA should be considered.
