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Moderate outcomes seen at 5-year follow-up after patellofemoral joint replacement

Results at 5-year follow-up showed the Femora Patella Vialli patellofemoral joint prosthesis yielded “moderate” outcomes, according to recently published results.

Researchers identified 43 Femora Patella Vialli patellofemoral joint prostheses (Wright Medical, United Kingdom ) implanted in 32 patients from April 2004 to December 2012. The mean follow-up was 65 months. Investigators reviewed outcomes for patients after they underwent patellofemoral arthroplasty. Intention to revise the implant was the primary outcome. Other outcomes included the Oxford and Kujala outcome scores.

Results showed one patient was lost to follow-up. For the remaining patients, the mean flexion was 110° at the final follow-up. Of the 42 knees, five needed revision to a total knee replacement due to progressive tibiofemoral osteoarthritis. Revisions were performed at a mean of 56 months. No radiographic loosening was seen in any case. Investigators noted the mean Oxford score improved from 18 points to 29 points. The Kujala score improved from 35 points to 58 points. – by Monica Jaramillo

Disclosures: The researchers report no relevant financial disclosures.

Results at 5-year follow-up showed the Femora Patella Vialli patellofemoral joint prosthesis yielded “moderate” outcomes, according to recently published results.

Researchers identified 43 Femora Patella Vialli patellofemoral joint prostheses (Wright Medical, United Kingdom ) implanted in 32 patients from April 2004 to December 2012. The mean follow-up was 65 months. Investigators reviewed outcomes for patients after they underwent patellofemoral arthroplasty. Intention to revise the implant was the primary outcome. Other outcomes included the Oxford and Kujala outcome scores.

Results showed one patient was lost to follow-up. For the remaining patients, the mean flexion was 110° at the final follow-up. Of the 42 knees, five needed revision to a total knee replacement due to progressive tibiofemoral osteoarthritis. Revisions were performed at a mean of 56 months. No radiographic loosening was seen in any case. Investigators noted the mean Oxford score improved from 18 points to 29 points. The Kujala score improved from 35 points to 58 points. – by Monica Jaramillo

Disclosures: The researchers report no relevant financial disclosures.

    Perspective
    Vicente Sanchis-Alfonso

    Vicente Sanchis-Alfonso

    The authors analyze the results of a second-generation patellofemoral arthroplasty implant, which has as a specific characteristic an asymmetrical trochlea with a long, steep lateral slope. It is an observational retrospective study with a small cohort of patients and only mid-term outcomes (mean follow-up 64 months [30 to 119 months]). Therefore, we cannot draw too many conclusions regarding the benefits of this implant. We would need to do a good quality clinical trial with long-term outcomes to evaluate the results and advantages of this implant. In my opinion, the most relevant aspect of this study is the fact that five knees (12%) were revised to total knee replacement because of pain and disability due to the progression to tibiofemoral osteoarthritis. The authors admit that three of these five cases required an early revision to TKR because of degenerative changes at the time of surgery in the tibiofemoral joint, specifically in weight-bearing areas. This means that patient selection was incorrect. I believe the most important element, and also the most difficult one, in surgery, and specifically in patellofemoral surgery, is the indication of a specific surgical technique. The ideal indication for patellofemoral arthroplasty is post-traumatic, isolated, severe patellofemoral OA and severe, isolated patellofemoral OA in a patient with severe trochlear dysplasia and a history of patellar dislocation. In these cases, we are bound to obtain the best outcome. However, these cases represent only 42% of all the cases of patellofemoral OA.

     

     

    • Vicente Sanchis-Alfonso, MD, PhD
    • Department of orthopaedic surgery
      Hospital Arnau de Vilanova
      Valencia, Spain

    Disclosures: Sanchis-Alfonso reports no relevant financial disclosures.

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