Trochleoplasty Is Associated With High Rates of Patellofemoral Arthritis: A Systematic Review
Cailan L Feingold1, Eric H Lin1, James C Dawahare2
1Department of Orthopaedic Surgery Keck School of Medicine of USC Los Angeles California U.S.A.
Purpose:
To identify 2- to 5- and >10-year complications of trochleoplasty and define rates of postoperative patellofemoral arthritis.
Methods:
PubMed, Embase, and Web of Science were queried for terms related to trochleoplasty. Included studies were clinical studies using trochleoplasty to manage patellofemoral instability and were published in English in peer-reviewed journals. Excluded studies were systematic reviews, meta-analyses, cadaveric studies, animal studies, and case reports. Patient demographics, follow-up time, concomitant procedures, complications, and subsequent surgeries were collected. Studies were grouped by follow-up time into <2, 2 to 5, 5 to 10, and >10 years.
Results:
Thirty-five studies met inclusion criteria with 1336 patients (64% female). There were 142 (10.6%) patients with less than 2 years of follow-up, 871 (65.2%) with 2 to 5 years, 221 (16.5%) with 5 to 10 years, and 102 (7.6%) with more than 10 years. The complication rates ranged from 0% to 33%. Seven (20%) studies specifically reported on postoperative arthritis. In patients with <2 years, the most common complication was arthrofibrosis at rates of 0% to 6.3%. Patellofemoral arthritis was the most common complication in patients with 2 to 5 (0%-35.3%), 5 to 10 (0%-17.4%), and >10 years of follow-up (0%-92.3%). In patients with more than 10 years of follow-up, rates of patellofemoral arthritis worse than Iwano grade 2 were as high as 65%. Recurrent instability rates varied widely across studies and follow-up times from 0% to 33.3%.
Conclusions:
Patients undergoing trochleoplasty for patellar instability may experience low rates of recurrence but are prone to postoperative stiffness at <2- and 2- to 5-year follow-up. Complications following trochleoplasty in isolation are worse than when concomitant procedures are done. After 10 years, the incidence of all patellofemoral arthritis is as high as 92%, and more severe patellofemoral arthritis is as high as 65%, which is greater than the progression in patients with patellofemoral instability.
Level Of Evidence:
Level IV, systematic review of Level II to IV studies.
