Severe isolated patellofemoral arthritis is a highly debilitating disease. Total knee arthroplasty is considered the gold standard treatment, however, patellofemoral arthroplasty has certain advantages. This ‘less invasive’ procedure preserves the tibiofemoral joint and cruciate ligaments, facilitating a more rapid recovery and allows for a relatively straightforward revision if required in the future. As the use of patellofemoral arthroplasty steadily gains popularity in the orthopaedic community, it is important to establish a consensus on which treatment should be the primary intervention of choice. Through background reading and expert opinion, three areas of research were chosen for further investigation: 1. Extensor mechanism efficiency 2. Survival and complication proportions following patellofemoral arthroplasty and total knee arthroplasty 3. Assessment of differences in function and quality of life outcomes following patellofemoral arthroplasty and total knee arthroplasty The purpose of this thesis was to further inform the debate between the choice of total knee arthroplasty and patellofemoral arthroplasty for the treatment of severe isolated patellofemoral arthritis. Study I: The cadaveric biomechanics study compared the extensor mechanism efficiency of the native knee, patellofemoral arthroplasty, cruciate-retaining total knee arthroplasty and posterior-stabilising total knee arthroplasty. Patellofemoral resultant force, peak pressure and contact area were also analysed. The data produced a bimodal distribution during the flexion-extension cycle for all four conditions. The results showed patellofemoral arthroplasty produced the greatest extensor mechanism efficiency in the range of mid flexion to extension (50° to 0°). Further research is required to determine whether this efficiency translates to the clinical setting. Study II: The systematic review compared the survival and complication proportions of patellofemoral arthroplasty and total knee arthroplasty. The patellofemoral arthroplasty studies were divided into seven groups depending on femoral component design. Thirty-six out of the forty studies identified were uncontrolled retrospective case series’ and therefore subject to reporting and selection biases and overall provided low quality evidence. A meta-analysis could not be performed due to high clinical heterogeneity. Other limitations included variations in study design and length of follow-up. Despite, these weaknesses the review established inlay designs produced the poorest survival and complication outcomes. Malpositioning/misalignment and disease progression were the most common complications. Study III: The double-blind randomised clinical trial assessed for differences in function and quality of life outcomes between patellofemoral arthroplasty and total knee arthroplasty. The trial failed to show evidence of a difference between the two interventions. Complication rates were overall low but greater in the total knee arthroplasty group. Tests for significance were not performed due to the small numbers involved. Although, the study was underpowered, the data did not support superiority of patellofemoral arthroplasty over total knee arthroplasty. Therefore, future studies should test for non-inferiority and involve multiple centres to increase generalizability to the wider orthopaedic community.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:675402 |
| Date | January 2015 |
| Creators | Joseph, Michelle |
| Publisher | University of Warwick |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://wrap.warwick.ac.uk/74832/ |
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