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British researchers find patellofemoral joint replacement not a temporizing measure to TKR
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SAN FRANCISCO — Primary total knee replacement (TKR) resulted in significantly better function and pain scores than patellofemoral joint replacement revised to a total knee, according to results of a retrospective, matched-cohort study presented here.
 Jonathan R. Hutt |
“We agreed with previously published literature that conversion of a patellofemoral joint [replacement] to a primary total knee is technically straight-forward,” Jonathan R. Hutt, MBBS, MRCS, of London, said at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. “However, in contrast to the previously published data, we have found that outcomes in terms of pain, function and quality of life were inferior when compared to a primary TKR. We would, therefore, caution against the use of a patellofemoral joint replacement as a more conservative bone preserving measure for those patients who may well eventually need a TKR due to progression of arthritis.”
He added, “We would suggest that there should be an emphasis on identification of those patients with true isolated patellofemoral disease who might benefit from this procedure.”
Using the records of five hospital trusts, Hutt and colleagues identified 21 patients with a mean age of 60 years who underwent patellofemoral joint replacements that were revised to a standard TKR after 3.2 years, mean. Most patients were revised for progression of osteoarthritis, Hutt said, however other causes of revision included implant malposition, patella button loosening, patella button fracture and unexplained pain.
There were no deep infections, additional revisions or significant component malposition as evidenced by radiograph.
The investigators compared the group to a cohort of primary TKR cases matched for age, gender, length of follow-up, operating surgeon and implant type. They found the primary TKR group had significantly better function than the patellofemoral replacement group based on the WOMAC score and Oxford Knee Score. The primary TKR group also showed superior pain scores on the Visual Analog Scale (VAS) and quality of life on the EuroQual-5D. However, the overall general quality of life measured by the VAS was not significantly different between the groups and investigators also found no significant difference between the groups for patient satisfaction.
Reference:
- Dodd MB, Bourke H, Bell, Hutt JR. Can the patellofemoral joint replacement be a pre-total knee replacement? Paper #6. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
- Disclosure: Hutt has no relevant financial disclosures.
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