Replacement for patellofemoral arthritis.

Area of Science:

• Orthopedic surgery
• Rheumatology
• Biomedical engineering

Background:

• Patellofemoral osteoarthritis (PFOA) is prevalent in individuals over 55, with higher incidence in females.
• Conservative treatments are common, but arthroplasty is indicated for end-stage PFOA.
• A debate exists regarding the superiority of total knee replacement (TKR) versus patellofemoral replacement (PFR) for PFOA.

Purpose of the Study:

• To review current evidence comparing TKR and PFR for the surgical management of PFOA.
• To inform clinical decision-making for patients with end-stage patellofemoral osteoarthritis.

Main Methods:

• Systematic review of recent meta-analyses, systematic reviews, and cohort studies on PFOA surgical management.
• Inclusion of institutional patient data.
• Content based on a lecture presented at the British Association for Surgery of the Knee 2019.

Main Results:

• PFOA is distinct from tibiofemoral osteoarthritis (TFOA).
• Patellofemoral replacement (PFR) demonstrates a higher failure rate compared to total knee replacement (TKR).
• Evidence suggests potentially better outcomes and recovery in the PFR group, though patient subsets show variable results.

Conclusions:

• Both PFR and TKR are viable surgical options for PFOA.
• Preoperative counseling and shared decision-making are essential for patient selection between TKR and PFR.
• Further research is needed to elucidate outcome differences between procedures and within PFOA patient subsets.