Summary

Patellofemoral arthroplasty (PFA) for isolated osteoarthritis shows return to sports (RTS) rates ranging from 64.7% to 91%, 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, but data on activity levels is scarce. This systematic review aims to evaluate return to sports (RTS) rates, factors influencing these outcomes and associated complications in patients undergoing PFA.

Methods

A systematic search was conducted until June 2024 in PubMed, EMBASE, ScienceDirect, and Scopus, following PRISMA guidelines. Search terms related to PFA, physical activity, and RTS were used. Inclusion criteria focused on clinical studies reporting RTS, while exclusion criteria involved studies without RTS or isolated PFA data. Out of 492 initially identified studies, 7 were included. Risk of bias was assessed using MINORS. Due to heterogeneity of results a narrative synthesis was conducted with report of ranges.

Results

Two prospective and five retrospective studies were included, involving 265 patients (281 knee, 64.6% women, mean age 48.9 years) with up to 5.3 years mean follow-up. RTS was variably defined (ranges 64.7-91%), low-impact sports were more common and 58.6% RTS before 6 months. In patients who RTS, 74.8% presented an activity level at least equal to their preoperative level. Postoperative pain decreased (VAS 6.3 to 2.7), but 38.6% of patients express that pain limited their activity. Conversion rate to total knee arthroplasty ranged from 6.3% to 13%, with reoperation rates between 10.4% and 25%.

Discussion

Variability in RTS rates highlights the relevance of adequate indication and the multifactorial nature of outcomes. Factors such as preoperative fitness, pain, motivation, and rehabilitation influence outcomes. Limitations include inconsistencies in definitions, reports of outcome measurements and non-standardized questionnaires. A personalized approach is necessary to optimize RTS and manage expectations.

Conclusion

PFA shows varying returns to recreational and sport activities ranging from 64.7% to 91%, mostly with low level impact. Reoperation and conversion to TKA are frequent at mid-term follow up