Page 26 - ISAKOS 2018 Winter Newsletter

CURRENT CONCEPTS
Patellofemoral Replacement
A meta-analysis comparing PFR with TKR for the treatment of isolated patellofemoral arthritis showed higher complication rates in association with PFR. In the PFR group, the most common reason for reoperation was mechanical problems, followed by persistent pain. Long-term survivorship was also lower for PFR than for TKR, with most common reason being the progression of tibiofemoral degeneration.
However, second-generation PFR was compared with TKR, the authors found no statistical differences in terms of the rates of reoperation, revision, persistent pain, or mechanical complications.
When necessary, revision of a PFR to a TKR can be easily performed and usually is done with a standard implant. Revision of a PFR was found to be comparable to a primary TKR and superior to a revision TKR in terms of surgical characteristics and postoperative clinical outcomes. However, both studies demonstrated higher complication rates in association with revision PFR that were similar to those associated with revision TKR.
Conclusion
Patellofemoral replacement is an attractive option for the treatment of advanced patellofemoral degeneration in that it is associated with less morbidity, improved function, and less bone loss than TKR. With careful patient selection and attention to surgical detail, good to excellent outcomes are seen in most patients. The primary cause of revision is progression of tibiofemoral arthritis. Revision of a PFR to a TKR has similar outcomes to primary TKR.
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24 ISAKOS NEWSLETTER 2018: VOLUME I