ABSTRACT
Patellofemoral arthroplasty (PFA) has emerged as an alternative bone-preserving surgical option for treating isolated symptomatic patellofemoral osteoarthritis that better replicates the natural knee kinematics compared with total knee arthroplasty. Achieving successful outcomes in PFA relies on meticulous patient selection, proper surgical technique, and appropriate implant choice and placement. Recent advancements in inlay trochlea implants, allowing for customized and anatomic joint line reconstruction with less bone resection, have demonstrated significant improvements in functional outcome scores and pain relief. This Technical Note aims to provide insights into the surgical technique of PFA with inlay implants, highlighting key considerations and potential challenges. It also assists surgeons in making informed decisions regarding the choice between standard and dysplastic inlay implants, while suggesting concurrent procedures to optimize tracking and overall outcomes.
ABSTRACT
OBJECTIVE: To review the long-term clinical results after revision surgery and the relationship between the different clinical variables involved with a failed total knee arthroplasty (TKA) and its evolution to provide a better understanding of the current treatment methods. METHODS: The present study involved 89 subjects with a failed knee arthroplasty that ended up requiring revision surgery and component replacement between 2011 and 2015. The study included patients with pain remaining after TKA and indication from the knee unit surgeon to review the implant, without presenting with thromboembolic or neurological changes that could bias the results. The demographic data, surgical information, type of implant, and causes of failure were analyzed. The patients subjected to replacement surgery were specifically asked to fill out clinical and satisfaction questionnaires (Lysholm and KOOS). The mean follow-up was 5.6 years (range, 3-11 years) and the analysis was divided into early revision (<5 years) and late revision (>5 years). The R statistical package version 3.2.5 for Windows was used, with significance less than 0.05 Cohort observational study. RESULTS: The results indicated that implant revisions accounted for 5.57% of total primary implants, with a mean survival of 6 years for primary prosthesis failure. The mean revision surgery result on the Lysholm knee scoring scale was 68.73 out of 100 points. A better score was obtained for revisions undertaken on TKA with over 5 years' survival and there were no significant differences in terms of the type of implant used. The causes of TKA failure were aseptic loosening (77.38%), instability (9.52%), and painful prosthesis (13.10%). The results were statistically significant when isolated revisions were performed on one component. Rating worse on most of the questionnaire subscales. CONCLUSION: The clinical results were better in primary implant replacements with at least 5 years' survival. The replacement of only one of the components (tibial or femoral) provided worse clinical results than total replacement.
