Does trochlear dysplasia influence short-term outcomes of trochlear-cutting patello-femoral arthroplasty
Author(s):
La Barbera G. (France)
,
La Barbera G. (France)
Affiliations:
Valoroso M.
,
Valoroso M.
Affiliations:
Pasqualotto S.
,
Pasqualotto S.
Affiliations:
Pungitore M.
,
Pungitore M.
Affiliations:
Valluy J.
,
Valluy J.
Affiliations:
Saffarini M.
,
Saffarini M.
Affiliations:
Dejour D.
Dejour D.
Affiliations:
ESSKA Academy. La Barbera G. 05/09/18; 209699; P12-1782 Topic: I4 - Trochleoplasty (open)
Dr. Giuseppe La Barbera
Dr. Giuseppe La Barbera
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Abstract
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Objectives: Most studies on patellofemoral arthroplasty (PFA) report outcomes and survival without considering the potential effects of patient aetiology and trochlear dysplasia. The purpose of this study was to evaluate outcomes of PFA over time depending on type of trochlear dysplasia and patellar shape.

Methods: The authors prospectively evaluated a consecutive series of 27 patients, aged 63.5±14 years (range, 41-86), who received PFA by the senior author. All patients had isolated patellofemoral arthritis (Iwano stage IV) and 66% had trochlear dysplasia (28% Dejour type A, 33% type B, 17% type C, and 22% type D). All patients had abnormal patellar (37% Wiberg II and 63% Wiberg III). The Tibial-Tuberosity to Trochlear Groove (TT-GT) distance and the patellar height were normal. All patients received the same trochlear-cutting implant and had partial lateral patellectomy. Subjective scores were collected pre-operatively and post-operatively at 2 months, 6 months, 1 year and 2 years, including the Oxford Knee Score (OKS), Knee injury and Osteoarthritis Outcome Score (KOOS) and new Knee Society Score (KSS). Uni- and bi-variable logistic regressions were performed to determine associations between outcomes for (i) different types of trochlear dysplasia and (ii) different patellar shapes.

Results: Revision to total knee arthroplasty was performed in 3 patients (13%) due to spread of arthritis to the tibiofemoral joint. The mean OKS improved from 40 pre-operatively, to 36 at 2 months, 26 at 6 months, 24 at one year, and 22 at the final follow-up. The KOOS symptoms subscale improved from 56 pre-operatively to 84 at the final follow-up; pain from 48 to 81; functions of daily living from 47 to 78; sports and recreation from 18 to 36; and quality of life from 26 to 62. The KSS satisfaction subscale increased from 15 pre-operatively to 30 at the final follow-up, and expectations decreased from 12 to 9. Neither uni- nor bi-variate regressions revealed any differences in outcomes for different types of trochlear dysplasia nor for different patellar shapes.

Conclusions: The outcomes of this series of PFA improved progressively between 6 and 12 months, and stabilized thereafter. Trochlear dysplasia and patellar shape did not influence short-term outcomes, likely because the trochlear-cutting implant corrected the underlying bone deformities, which enabled restoration of normal patellofemoral alignment and congruence.

Keywords:
Patello-femoral arthroplasty, Trochlear dysplasia, Patello-femoral osteoarthritis
Objectives: Most studies on patellofemoral arthroplasty (PFA) report outcomes and survival without considering the potential effects of patient aetiology and trochlear dysplasia. The purpose of this study was to evaluate outcomes of PFA over time depending on type of trochlear dysplasia and patellar shape.

Methods: The authors prospectively evaluated a consecutive series of 27 patients, aged 63.5±14 years (range, 41-86), who received PFA by the senior author. All patients had isolated patellofemoral arthritis (Iwano stage IV) and 66% had trochlear dysplasia (28% Dejour type A, 33% type B, 17% type C, and 22% type D). All patients had abnormal patellar (37% Wiberg II and 63% Wiberg III). The Tibial-Tuberosity to Trochlear Groove (TT-GT) distance and the patellar height were normal. All patients received the same trochlear-cutting implant and had partial lateral patellectomy. Subjective scores were collected pre-operatively and post-operatively at 2 months, 6 months, 1 year and 2 years, including the Oxford Knee Score (OKS), Knee injury and Osteoarthritis Outcome Score (KOOS) and new Knee Society Score (KSS). Uni- and bi-variable logistic regressions were performed to determine associations between outcomes for (i) different types of trochlear dysplasia and (ii) different patellar shapes.

Results: Revision to total knee arthroplasty was performed in 3 patients (13%) due to spread of arthritis to the tibiofemoral joint. The mean OKS improved from 40 pre-operatively, to 36 at 2 months, 26 at 6 months, 24 at one year, and 22 at the final follow-up. The KOOS symptoms subscale improved from 56 pre-operatively to 84 at the final follow-up; pain from 48 to 81; functions of daily living from 47 to 78; sports and recreation from 18 to 36; and quality of life from 26 to 62. The KSS satisfaction subscale increased from 15 pre-operatively to 30 at the final follow-up, and expectations decreased from 12 to 9. Neither uni- nor bi-variate regressions revealed any differences in outcomes for different types of trochlear dysplasia nor for different patellar shapes.

Conclusions: The outcomes of this series of PFA improved progressively between 6 and 12 months, and stabilized thereafter. Trochlear dysplasia and patellar shape did not influence short-term outcomes, likely because the trochlear-cutting implant corrected the underlying bone deformities, which enabled restoration of normal patellofemoral alignment and congruence.

Keywords:
Patello-femoral arthroplasty, Trochlear dysplasia, Patello-femoral osteoarthritis
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