Replacement for patellofemoral arthritis

Patellofemoral osteoarthritis (PFOA) is relatively common, affecting 24% females and 11% males over the age of 55 years. Most patients can be treated conservatively. Arthroplasty remains the ultimate procedure for end stage PFOA. Debate continues as to whether total knee replacement (TKR) or patellofemoral replacement (PFR) is better for this group of patients. The aim of this article is to review the current evidence for use of these two procedures in this condition.

Recent meta-analyses, systematic reviews and appropriate cohort publications concerning surgical management of PFOA were sourced. A cohort of patients from the authors' own institution was also reviewed. An instructional lecture was then created and delivered at the British Association for Surgery of the Knee 2019 annual conference, on behalf of the British Patellofemoral Society. This article has been written based on this lecture.

It is clear that PFOA is a different disease process than tibiofemoral osteoarthritis (TFOA). There is no doubt that PFR has a higher failure rate than TKR, but evidence suggests that outcomes and recovery may be better in the PFR group. This is complicated by subsets of those with PFOA faring better than others, the reasons for which are likely to be multifactorial.

Both PFR and TKR may be used appropriately for PFOA. In keeping with a shared decision-making process, patients should be counselled appropriately preoperatively when deciding between these procedures. Further research is required to understand the differences in outcome between procedures and in subsets of patients with PFOA.