Robotic-assisted patellofemoral arthroplasty shows high rate of return to low-impact sport
Key takeaways:
- Robotic-assisted patellofemoral arthroplasty may be a treatment option for younger patients with patellofemoral arthritis.
- Patients reported high rates of return to low-impact sports and activity.
Robotic-assisted patellofemoral arthroplasty yielded high rates of return to low-impact sports and activity for patients aged 50 years and younger with patellofemoral arthritis, according to published results.
Frank R. Noyes, MD, and colleagues performed a prospective study of 44 patients aged 21 to 50 years (mean age, 37.2 years) who underwent 51 robotic-assisted patellofemoral arthroplasty procedures between 2009 and 2018. Mean follow-up was 5.3 years. According to the study, 45 knees were included in the clinical analysis.
Outcome measures included the Cincinnati Knee Rating System for sports activity and symptoms, patient psychometric ratings of substantial clinical benefit, patient-acceptable symptom state, VAS pain scores, SF-12 survey scores and survivorship, which was defined by conversion to total knee replacement.
Preoperatively, 78% of patients (n = 35 knees) were unable to perform recreational sports due to their symptoms. In addition, 20% of patients (n = 9 knees) were able to perform low-impact sports. Researchers found moderate to severe pain scores in 91% of knees, preoperatively.
Postoperatively, 80% of patients (n = 36 knees) were able to perform low-impact sports, with 7% of patients (n = 3 knees) able to perform jumping and pivoting sports. Patients reported substantial clinical benefit for 87% of knees with good, very good or normal scores.
At final follow-up, 89% of patients were pleased with surgery and 93% would undergo surgery again. Researchers found moderate to severe pains scores in 11% of knees, postoperatively. Among all patients, 10% were converted to TKR.
“The robotic-assisted [3D] preoperative planning allowed precise intraoperative trochlear implant alignment in knees with severe trochlear dysplasia,” the researchers wrote in the study. “[Patellofemoral arthroplasty] PFA is recommended as an alternative treatment in younger patients with end-stage symptomatic patellofemoral arthritis.”
Perspective
Back to TopWe commend the authors for their excellent work and outstanding follow-up rate of 98% and agree that patellofemoral joint replacement is a powerful operation for patients with isolated patellofemoral osteoarthritis that consistently yields a high rate of return to sport and significant improvement in quality of life and functionality postoperatively.
In our own patient series of 48 patients who underwent patellofemoral arthroplasty, the mean age was 51.6 years. Our ideal age for patellofemoral arthroplasty is patients older than 40 years. For patients younger than 40 years with unloadable chondral or osteochondral lesions, we prefer offloading tibial tubercle osteotomy with concomitant cartilage restoration as either a definitive or bridging procedure to arthroplasty at a later stage. However, patients with end-stage diffuse patellofemoral osteoarthritis not amenable to offloading are exceptions to this age guideline and patellofemoral arthroplasty can be indicated in younger ages on a case-by-case basis when appropriate.
These results from Frank R. Noyes, MD, and colleagues are encouraging for all patients who may be considering patellofemoral arthroplasty as a treatment option for advanced patellofemoral arthritis.
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