PMID- 33125548
OWN - NLM
STAT- MEDLINE
DCOM- 20210426
LR  - 20210426
IS  - 1434-3916 (Electronic)
IS  - 0936-8051 (Print)
IS  - 0936-8051 (Linking)
VI  - 140
IP  - 12
DP  - 2020 Dec
TI  - Preoperative patellofemoral anatomy affects failure rate after isolated 
      patellofemoral inlay arthroplasty.
PG  - 2029-2039
LID - 10.1007/s00402-020-03651-9 [doi]
AB  - PURPOSE: To analyze whether preoperative patellofemoral anatomy is associated 
      with clinical improvement and failure rate after isolated patellofemoral 
      arthroplasty (PFA) using a modern inlay-type trochlear implant. METHODS: 
      Prospectively collected 24 months data of patients treated with isolated inlay 
      PFA (HemiCAP((R)) Wave, Arthrosurface, Franklin, MA, USA) between 2009 and 2016, 
      and available digitalized preoperative imaging (plain radiographs in three planes 
      and MRI) were retrospectively analyzed. All patients were evaluated using the 
      WOMAC score, Lysholm score, and VAS pain. Patients revised to TKA or not 
      achieving the minimal clinically important difference (MCID) for the total WOMAC 
      score or VAS pain were considered failures. Preoperative imaging was analyzed 
      regarding the following aspects: Tibiofemoral OA, patellofemoral OA, trochlear 
      dysplasia (Dejour classification), patellar height (Insall-Salvati index [ISI]; 
      Patellotrochlear index [PTI]), and position of the tibial tuberosity (TT-TG and 
      TT-PCL distance). RESULTS: A total of 41 patients (61% female) with a mean age of 
      48 +/- 13 years could be included. Fifteen patients (37%) were considered failures, 
      with 5 patients (12%) revised to TKA and 10 patients (24%) not achieving MCID for 
      WOMAC total or VAS pain. Failures had a significantly higher ISI, and a 
      significantly lower PTI. Furthermore, the proportion of patients with a 
      pathologic ISI (> 1.2), a pathologic PTI (< 0.28), and without trochlear 
      dysplasia were significantly higher in failures. Significantly greater 
      improvements in clinical outcome scores were observed in patients with a higher 
      preoperative grade of patellofemoral OA, ISI </= 1.2, PTI >/= 0.28, TT-PCL 
      distance </= 21 mm, and a dysplastic trochlea. CONCLUSION: Preoperative 
      patellofemoral anatomy is significantly associated with clinical improvement and 
      failure rate after isolated inlay PFA. Less improvement and a higher failure rate 
      must be expected in patients with patella alta (ISI > 1.2 and PTI < 0.28), 
      absence of trochlear dysplasia, and a lateralized position of the tibial 
      tuberosity (TT-PCL distance > 21 mm). Concomitant procedures such as tibial 
      tuberosity transfer may, therefore, be considered in such patients. LEVEL OF 
      EVIDENCE: Level III, retrospective analysis of prospectively collected data.
FAU - Feucht, Matthias J
AU  - Feucht MJ
AD  - Department for Orthopedic Sports Medicine, Technical University Munich, 
      Ismaninger Str. 22, 81675, Munich, Germany. matthias.feucht@gmx.net.
AD  - Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of 
      Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany. 
      matthias.feucht@gmx.net.
FAU - Lutz, Patricia M
AU  - Lutz PM
AD  - Department for Orthopedic Sports Medicine, Technical University Munich, 
      Ismaninger Str. 22, 81675, Munich, Germany.
FAU - Ketzer, Conrad
AU  - Ketzer C
AD  - Department for Orthopedic Sports Medicine, Technical University Munich, 
      Ismaninger Str. 22, 81675, Munich, Germany.
FAU - Rupp, Marco C
AU  - Rupp MC
AD  - Department for Orthopedic Sports Medicine, Technical University Munich, 
      Ismaninger Str. 22, 81675, Munich, Germany.
FAU - Cotic, Matthias
AU  - Cotic M
AD  - Department for Orthopedic Sports Medicine, Technical University Munich, 
      Ismaninger Str. 22, 81675, Munich, Germany.
FAU - Imhoff, Andreas B
AU  - Imhoff AB
AD  - Department for Orthopedic Sports Medicine, Technical University Munich, 
      Ismaninger Str. 22, 81675, Munich, Germany.
FAU - Pogorzelski, Jonas
AU  - Pogorzelski J
AD  - Department for Orthopedic Sports Medicine, Technical University Munich, 
      Ismaninger Str. 22, 81675, Munich, Germany.
LA  - eng
PT  - Journal Article
DEP - 20201030
PL  - Germany
TA  - Arch Orthop Trauma Surg
JT  - Archives of orthopaedic and trauma surgery
JID - 9011043
SB  - IM
MH  - Adult
MH  - Arthroplasty/*methods
MH  - Female
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Minimal Clinically Important Difference
MH  - Osteoarthritis, Knee/*surgery
MH  - Patella/anatomy & histology/diagnostic imaging
MH  - Patellofemoral Joint/anatomy & histology/diagnostic imaging/*surgery
MH  - Posterior Cruciate Ligament/anatomy & histology/diagnostic imaging
MH  - Radiography
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Tibia/anatomy & histology/diagnostic imaging
MH  - Treatment Failure
PMC - PMC7674339
OTO - NOTNLM
OT  - Malalignment
OT  - Patella alta
OT  - Patellar maltracking
OT  - Patellofemoral arthroplasty
OT  - TT-PCL
OT  - TT-TG
OT  - Trochlear dysplasia
COIS- Andreas B. Imhoff is a consultant for Arthrosurface and receives royalties from 
      the company. Arthrosurface also funded a research project in the past 5 years, 
      which, however, is completely unrelated to this project. The company never had 
      any influence on the setup, results or writing of the study.
EDAT- 2020/10/31 06:00
MHDA- 2021/04/27 06:00
PMCR- 2020/10/30
CRDT- 2020/10/30 17:14
PHST- 2020/06/30 00:00 [received]
PHST- 2020/10/15 00:00 [accepted]
PHST- 2020/10/31 06:00 [pubmed]
PHST- 2021/04/27 06:00 [medline]
PHST- 2020/10/30 17:14 [entrez]
PHST- 2020/10/30 00:00 [pmc-release]
AID - 10.1007/s00402-020-03651-9 [pii]
AID - 3651 [pii]
AID - 10.1007/s00402-020-03651-9 [doi]
PST - ppublish
SO  - Arch Orthop Trauma Surg. 2020 Dec;140(12):2029-2039. doi: 
      10.1007/s00402-020-03651-9. Epub 2020 Oct 30.