Patellofemoral arthroplasty provides similar long-term survival rate and complications with better clinical outcomes compared to facetectomy for the treatment of isolated patellofemoral osteoarthritis

Abstract

Purpose

This study aimed to analyse the clinical outcomes and survival of patellofemoral arthroplasty (PFA) in treating isolated patellofemoral osteoarthritis (IPFOA) at our centre. The secondary objective was to compare these results with a historical cohort treated with partial lateral facetectomy plus Insall realignment (PLFIR). We hypothesised that clinical outcomes and survival with PFA are superior to PLFIR and comparable to the literature.

Methods

A retrospective analysis of 120 patients with IPFOA was conducted. The PFA series included 33 patients treated between 2012 and 2019 with a minimum follow-up of 5 years (range 1.2–12.1 years). The PLFIR historical cohort treated between 1995 and 2002 (range 4.1–15.7 years) consisted of 87 patients. Preoperative and post-operative clinical outcomes were assessed using the Knee Society Score (KSS) and Kujala score, and survivorship was evaluated via Kaplan–Meier analysis. Cox regression analysis was used to identify factors influencing surgical failure.

Results

The PFA group demonstrated a 75.8% survival rate at 10 years, with a 24.2% failure rate requiring conversion to total knee arthroplasty (TKA). In the PLFIR group, the 10-year survival rate was 79.3%, although 26.4% required TKA. Both groups exhibited significant improvements in KSS and Kujala score, with PFA showing superior Kujala score improvement (p = 0.012). No statistically significant difference in survival between the two groups was observed at 10 years (p = 0.056), but PFA showed better long-term clinical outcomes.

Conclusions

PFA demonstrated comparable survival rates to PLFIR in the treatment of IPFOA. Despite a higher initial failure rate, PFA showed a potential for greater improvement in the long term, particularly in terms of anterior knee pain.

Level of Evidence

Level IV, retrospective case series analysis compared with a historical cohort.