Summary
Patellofemoral arthroplasty (PFA) for isolated osteoarthritis shows a 68.2% return to sports (RTS) rate, mainly in low-impact activities. Despite functional improvements and pain reduction, 38.6% of patients still face pain that limits sports participation. RTS outcomes are heterogeneous and influenced by multiple factors.
Abstract
Introduction
Patellofemoral arthroplasty (PFA) is an established treatment for isolated patellofemoral osteoarthritis, with recent literature exploring its impact on return to sports (RTS). This systematic review aims to evaluate RTS rates and the factors influencing these outcomes in patients undergoing PFA.
Methods
A systematic search was conducted up to June 2024 in PubMed/MEDLINE, EMBASE, ScienceDirect, and Scopus, according to PRISMA guidelines. The terms used for the search strategy included "patellofemoral arthroplasty," "patellofemoral joint replacement," "sports," , “return to sports” and "activity"; 492 studies were identified. Non-clinical studies, those without patient-reported outcomes or RTS data, and studies with multiple interventions without specific PFA data were excluded. Six studies reporting PFA outcomes focused on RTS were included.
Results
Two prospective studies and four retrospective studies covering 258 knees (241 patients) with an average follow-up of up to 5.3 years were included. Of the patients, 68.9% were women, with a mean age of 48 years. The pooled RTS rate was 68.2%. Among those who returned to sports, 76.5% achieved an equal or higher activity level, primarily in low-impact sports. Functional scales showed improvement, and pain according to the visual analog scale (VAS) decreased from 6.3 to 2.7, limiting sports activity in 38.6% of patients. Time to return to sports was evaluated in only one study, showing a 56.8% return at 6 months and 17% of patients not returning due to non-knee-related causes. The conversion rate to total knee arthroplasty was up to 13%.
Conclusion
PFA shows variable results in survival and improvements in activity levels. RTS is evaluated descriptively, heterogeneously, and non-standardized. RTS in PFA is multifactorial, not without complications, and tends to involve low-impact activities. Pain remains a limiting factor for recreational activities despite surgery.