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Asymptomatic Radiological Patellofemoral Osteoarthritis Does Not Affect Outcomes in Fixed Bearing Unicompartmental Knee Arthroplasty


Justin Boey
SINGAPORE

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Asymptomatic Radiological Patellofemoral Osteoarthritis Does Not Affect Outcomes in Fixed Bearing Unicompartmental Knee Arthroplasty

Justin Boey, SINGAPORE William Yeo, MPhty, SINGAPORE Vincent Antonio, MBBS, PHILIPPINES Seng-Jin Yeo, MBBS, FRCS, SINGAPORE

Singapore General Hospital, Singapore, Singapore, SINGAPORE

2013 Congress   Paper Abstract   2013 Congress   Not yet rated

 

Anatomic Location

Knee Patellofemoral

Anatomic Structure

Cartilage

Diagnosis / Condition

Osteoarthritis

Diagnosis Method

Physical Examination X-ray

Sports Medicine

Outcome Studies

Treatment / Technique

Arthroplasty Implant Total Joint Replacement

Patellofemoral

Patellofemoral Osteoarthritis

Summary: The results support the proposition that in patients treated with fixed bearing UKAs for medial compartment arthritis of the knee, the presence of radiological evidence osteoarthritis of the PFJ does not affect the functional and quality of life outcomes.

Introduction

There are differences in opinion on whether the presence of asymptomatic pre-operative radiographic changes of the patellofemoral joint(PFJ) should be a contraindication to using a unicompartmental knee arthroplasty(UKA) for medial compartment arthritis of the knee. Presently, there is literature to support the use of mobile bearing UKAs in this group of patients. The purpose of our study is ascertain if similar outcomes can be achieved with the use of fixed bearing UKAs

Methods

A retrospective review of the hospital joint replacement registry of patients who underwent UKA from January 2004 to June 2009 for medial compartment osteoarthritis. All patients were asymptomatic for PFJ osteoarthritis. Informed consent and ethics approval were obtained.

Patients were divided into two groups, those with pre-operative radiographic changes of the PFJ on the skyline view and those without. The radiographs were evaluated to assess for osteoarthritic PFJ changes and graded using Jones criteria by 2 blinded reviewers.

Clinical outcomes were measured prospectively by an independent diagnostic center at pre-operation, 6 months and 2 years post-operation. Outcomes measured include: Knee Society Score, Oxford Knee Score and the Short Form 36 Questionnaire (SF-36).

Mann-Whitney Test was performed to test for statistical significance of results using SPSS 16.0. Differences were considered to be significant at a probability level of 95% (P=0.05).

Results

There were 468 consecutive knees from 400 patients who underwent UKA for medial compartment osteoarthritis. There were 245 female and 155 male patients with mean age of 62.3 years old (42y-88y) and mean body mass index of 23.6kg/m2 (21.3-28.5kg/m2). Follow-up rate at 2 years was 99.3% (393 out of 400 patients which corresponds to 461 out of 468 operated knees).

PFJ changes were noted in 310 knees (66.2%) with grade 1 changes in 143 knees (30.6%), grade 2 changes in 139 knees (29.7%) and grade 3 in 28 knees (5.9%).

Study groups were comparable as there were no significant differences in clinical outcome scores at pre-operation (p>0.05). There were no significant differences in SF-36 {p=(SF1-SF8) 0.07, 0.68, 0.11, 0.72, 0.35, 0.31, 0.12, 0.15}, Oxford Knee Scores (p=0.31) and Knee Society Scores (p= 0.31 and 0.94) between patients who had PFJ changes and patients who did not at 6 months and 2 years follow-up.

Conclusion

The results support the proposition that in patients treated with fixed bearing UKAs for medial compartment arthritis of the knee, the presence of radiological evidence osteoarthritis of the PFJ does not affect the functional and quality of life outcomes.