High survivorship and excellent functional outcome in third-generation patellofemoral arthroplasty

This study presents the short- to mid-term implant survival rates, along with the clinical and radiographic outcomes, in a consecutive series of patients who underwent third-generation patellofemoral arthroplasty (PFA) at a non-designer centre. Additionally, it explores the impact of prior surgery on clinical outcomes following PFA.

A retrospective analysis of prospectively collected data was conducted for 27 PFAs performed in 23 patients between 2016 and 2023 using the Gender Solutions® Patello-Femoral Joint System. Patients had a mean follow-up of 4.3 years, with clinical assessments including the Oxford Knee Score (OKS), Visual Analogue Scale (VAS), Forgotten Joint Score (FJS), and activity levels (TAS, UCLA). Implant survivorship was analysed using Kaplan-Meier estimators, with endpoints of revision and reoperation.

The mean age at time of surgery was 51.7 ± 10.5 years, with 92.6% of patients being women. The mean body mass index (BMI) was 28.3 ± 4.5. The 5-year implant survival rate was 100% for revisions and 96.3% for reoperations. Statistically significant improvements were observed in OKS (24.7 ± 8.0 to 39.2 ± 8.3, p < 0.001), VAS (7.1 ± 2.3 to 2.3 ± 2.8, p < 0.001) and range of motion (ROM) (122.1° ± 17° to 134.7° ± 6.8°, p = 0.007). Over 85% of patients achieved good to excellent OKS scores, with 92.3% reporting satisfaction. Patients with prior surgery on the affected knee showed higher satisfaction and greater ROM improvement. Obesity was associated with minor reductions in ROM but did not significantly impact overall outcomes.

The short- to mid-term results following third-generation PFA demonstrated high survivorship and excellent clinical outcomes in an independent series. Prior surgery and obesity were not associated with poorer clinical outcomes, supporting the consideration of PFA for these patients when appropriately indicated.

Level III, retrospective cohort study.