Complications after patello-femoral versus total knee replacement in the treatment of isolated patello-femoral osteoarthritis. A meta-analysis

C. J. Dy, N. Franco, Y. Ma, M. Mazumdar, M. M. McCarthy, A. Gonzalez Della Valle

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Abstract

Purpose: Both patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA) are successful in treating isolated patellofemoral osteoarthritis, but the complication rates after PFA are concerning. We performed a meta-analysis to compare the incidence of complications, re-operations, and revision following PFA and TKA for patellofemoral osteoarthritis. Methods: We systematically identified publications with patients who underwent PFA or TKA for patellofemoral osteoarthritis with minimum 1.5 year follow-up. Demographics, implant (TKA, first [1G] or second-generation [2G] PFA), complications, and cause of re-operations were extracted. Random-effects meta-analysis was used to pool incidence data, which was compared between groups using logistic regression to adjust for length of follow-up. Results: Twenty-eight observational studies and no randomized trials were included in this meta-analysis, which limits its generalizability. There was a higher likelihood of any re-operation (odds ratio 8.06) and revision (OR 8.11) in PFA compared to TKA. Re-operation (OR 4. 33) and revision (OR 4.93) were more likely in 1G-PFA than 2G-PFA. When comparing 2G-PFA to TKA, there was no significant difference in re-operation, revision, pain, or mechanical complications. Conclusions: Patients who undergo PFA rather than TKA are more likely to experience complications and require re-operation or revision, but subgroup analysis suggests a relation to implant design. There is no significant difference in re-operation, revision, pain, or mechanical complications between 2G-PFA and TKA. Level of evidence: Systematic review of Level III therapeutic studies, Level III.

Original languageEnglish
Pages (from-to)2174-2190
Number of pages17
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume20
Issue number11
DOIs
StatePublished - Nov 2012

Keywords

  • Patellofemoral arthritis
  • Patellofemoral arthroplasty
  • Patellofemoral replacement
  • Total knee arthroplasty
  • Total knee replacement

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