Preoperative bone scan useful in patient selection for patellofemoral joint arthroplasty
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According to study results, a preoperative bone scan to confirm isolated patellofemoral arthritis may be useful to help select patients for patellofemoral joint arthroplasty.
“Based on this study and the available literature, we would recommend the use of a preoperative bone scan as a helpful tool in the selection process for patients considering isolated [patellofemoral joint arthroplasty] PFA,” the authors wrote.
Researchers retrospectively reviewed data for 32 patients who underwent isolated patellofemoral arthroplasty for patellofemoral arthritis with the same implant design (Gender Solutions PFJ, Zimmer). Patients had an average follow-up of 52 months. MRI was used in 16 patients to confirm isolated patellofemoral arthritis. Their average follow-up was 63 months. The groups were not different with regard to age, BMI, follow-up or preoperative range of motion.
Results showed 100% survivorship in patients who were confirmed with a preoperative bone scan. Five of the 16 patients in which MRI was used to determine isolated patellofemoral arthritis needed revision surgery with conversion to total knee arthroplasty. Patients who were confirmed with MRI needed revision because of progression of knee arthritis in the tibial-femoral joint, according to results. No implant-related failures were seen. – by Monica Jaramillo
Disclosures: Baker reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Alejandro Gonzalez Della Valle, MD
Patellofemoral arthroplasty was introduced in the late 1970s. Since then, there have been substantial improvements in implant design and surgical technique. Still, 45% of patients who undergo patellofemoral arthroplasty require revision surgery within 15 years in the Australian National Arthroplasty Registry, emphasizing the need for careful patient selection. MRI, with its ability to depict articular cartilage and menisci, is the preferred noninvasive modality to study articular cartilage and is widely used for patellofemoral arthroplasty (PFA) patient selection. The interesting study by Baker and colleagues examined the role of three-phase bone scan and MRI in patient selection for PFA. In their retrospective analysis of 32 patients who underwent PFA, 16 of them had a preoperative bone scan to confirms isolated patellofemoral arthritis. They were matched with 16 patients who had isolated patellofemoral arthritis diagnosed with a preoperative MRI. After an average follow-up of 52 months (range: 29 to 115 months), revision surgery was required in none of the patients with a preoperative bone scan and in five of the 16 patients who had a preoperative MRI. The study highlights the role of three-phase bone scan for the detection of subchondral bone damage resulting from early articular cartilage wear, which may not be evident in MRI. Additional follow-up is required to assess its impact on the long-term survivorship of PFA.
Hospital for Special Surgery
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