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Ipsilateral Knee Reoperation Rates Following Patello-Femoral Arthroplasty: Analysis of a Statewide Database
Amanda Avila1, Sallie Yassin2, Kobe Rodney1
1Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
Background:
Patello-femoral arthroplasty (PFA) is a mainstay treatment of isolated patello-femoral osteoarthritis. Despite comparable outcomes to total knee arthroplasty, the reoperation rate following PFA remains poorly characterized in the literature. This study aimed to determine the cumulative incidence and temporal patterns of ipsilateral knee reoperation following primary PFA.
Methods:
A retrospective cohort study was conducted using a statewide all-payer claims database. Adults undergoing primary PFA between 2017 and 2024 were identified (N = 3,715). The primary outcome was time to first ipsilateral reoperation, which was categorized into arthroplasty, instability procedures, arthrofibrosis, and infection-related procedures. Cumulative incidence functions and Fine-Gray competing-risks regression models were used to evaluate the risk of ipsilateral knee reoperation, reported as sub-distribution hazard ratios (sHR) and risk factors following PFA.
Results:
The cohort had a median age of 56 years (interquartile range, 45.0 to 65.0), and 60.2% were women. The median follow-up time was 2.1 years (interquartile range, 0.4 to 4.5). The cumulative incidence of any reoperation was 15.2% at one year, 18.3% at two years, and 21.8% at five years. At five years, arthroplasty represented the most common reoperation subtype (9.1%), followed by instability procedures (4.3%) and arthroscopy (4.2%). Prior patella dislocation (sHR, 2.45 [95% confidence interval, 1.99 to 3.01]; P < 0.001) and prior ipsilateral knee surgery (sHR, 2.39 [95% confidence interval, 1.59 to 3.59]; P < 0.001) were independently associated with increased reoperation risk across multiple categories.
Conclusions:
The 21.8% 5-year reoperation rate reported in this study exceeds previously reported revision rates, reflecting a substantial surgical burden going beyond conversion to total knee arthroplasty. Prior patella dislocation and prior ipsilateral surgery represent notable risk factors for reoperation. These findings underscore the substantial burden that PFA reoperation imposes on patients, providers, and payers.
