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5-Year Results After Isolated Patellofemoral Inlay Resurfacing Arthroplasty - A Prospective Study
ESSKA Academy. Pogorzelski J. May 11, 2018; 218048
Jonas Pogorzelski
Jonas Pogorzelski
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Abstract
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Objectives: Although the implantation of patellofemoral arthroplasty systems has been used for more than 30 years, it remains a challenging procedure. Patient selection remains the key factor fur successful mid-term outcomes. However, drawbacks of prosthetic designs such as onlay-designs are believed to be partially responsible for failures of early implant concepts. As a result, a different type of prosthesis with an inlay-design was developed recently. As long-term results of this type of prosthesis are rare, the purpose of this study was to prospectively evaluate the clinical 5-year results after isolated patellofemoral inlay resurfacing (PFIR) arthroplasty.

Methods: In this IRB-approved study with prospectively-collected data, all patients had undergone PFIR arthroplasty implantation and were at least five years out from surgery. Patients with concomitant surgery on the index knee were excluded from the study. The overall Western Ontario and McMaster Universities Arthritis Score (WOMAC), Tegner Activity Scale and Pain Visual Analog Scale (Pain VAS) was collected pre- and postoperatively. Additionally, all patients underwent radiographic examination at final follow up. Failure was defined as conversion to total knee arthroplasty.

Results: From 09/2009 to 04/2012, a total of 30 isolated PFIR procedures were performed in 29 patients (19 male, 10 female, mean age of 47.6±11.8 years at surgery). All knees demonstrated significant baseline symptoms refractory to conservative care and 73.3% (n=22) of all patients underwent prior surgical interventions. Of the 29 patients available, seven patients refused participation prior to enrollment and one patient passed away from unrelated causes. Four patients were converted to a total knee replacement and thus considered failures; one patient suffered from an allergic reaction against chrome/nickel while the remaining three suffered from persistent pain. Finally, the remaining 17 patients (18 knees) could be included into the statistical analysis. At a mean follow-up of 63.3 ± 3.5 months, the following medians and interquartile ranges (25th-75th percentile, Q1,Q3) could be observed: The median Pain Vas decreased significantly (p = 0.001) from 5 (Q1:4; Q3:7) preoperatively to 2 (Q1:0; Q:3) postoperatively. The median Tegner Activity Scale score did not drop significantly (p = 0.408) from 3 points (Q1:2; Q3:4) preoperatively to 3 points (Q1:2; Q3:4) postoperatively. The median overall WOMAC score increased significantly (p = 0.007) from 67 (Q1:58; Q3:72) preoperatively to 90 (Q1:72; Q3:91) postoperatively. Radiographically, no significant progression of the tibiofemoral Kellgren Score (KS) could be observed.

Conclusions: At minimum five-year follow-up, patients treated with an inlay patellofemoral resurfacing arthroplasty can expect good clinical outcomes with little postoperative pain and a low failure rate. Moreover, no significant progression of tibiofemoral osteoarthritis could be detected and the level of sport ability could be maintained.

Keywords:
patellofemoral resurfacing arthroplasty; inlay-design;midterm outcomes
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