Patellofemoral Arthroplasty Improves Patellofemoral Alignment in Patients with Patellofemoral Osteoarthritis with Trochlear Dysplasia

2020 ◽  
Author(s):  
Guangmin Yang ◽  
Jue Wang ◽  
Yike Dai ◽  
Wei Lin ◽  
Jinghui Niu ◽  
...  
Keyword(s):  
Trochlear Dysplasia ◽  
Oxford Knee Score ◽  
Trochlear Groove ◽  
Knee Score ◽  
Patellofemoral Osteoarthritis ◽  
Patellofemoral Arthroplasty ◽  
Patient Reported ◽  
Patellofemoral Alignment ◽  
The Impact

AbstractThe impact of trochlear dysplasia on patellofemoral arthroplasty (PFA) has rarely been reported in the literature. The purpose of this study was to explore the effectiveness of PFA in patients with patellofemoral osteoarthritis (PFOA) associated with trochlear dysplasia. From January 2014 to March 2018, 35 patients with PFOA and trochlear dysplasia (29 females and 6 males), underwent PFA, were included in the present retrospective study. Radiological measurements including the patellar tilt (PT), congruence angle (CA), Blackburne–Peel ratio (BPR), tibial tuberosity–trochlear groove (TT–TG) distance, and lateral trochlear inclination (LTI) were assessed pre- and postoperatively to evaluate the changes in patellofemoral alignment. The patient-reported functional outcome was assessed using the Oxford Knee Score. The mean follow-up time was 24 months (range, 18–42 months). The intraclass correlation coefficients were excellent for all measurements. The patellofemoral alignment and knee function were significantly improved postoperatively. The PT decreased from 23.3 ± 6.3 degrees preoperatively to 6.4 ± 2.3 degrees postoperatively (p < 0.001). The CA decreased from 32.3 ± 8.6 degrees preoperatively to 10.2 ± 3.6 degrees postoperatively (p < 0.001). The lateral trochlear inclination increased from 8.3 ± 4.1 degrees preoperatively to 16.0 ± 1.2 degrees postoperatively (p < 0.001). The TT–TG distance decreased from 18.2 ± 3.8 mm preoperatively to 11.5 ± 3.3 mm postoperatively (p < 0.001). The BPR did not significantly change postoperatively (p = 0.390). The average Oxford Knee Score improved from 19.5 preoperatively to 29.2 at 6 months postoperatively (p < 0.001), 37.9 at 1 year postoperatively (p < 0.001), and 39.1 at final follow-up (p < 0.001). No patient developed patellofemoral malalignment or prosthesis loosening during short-term follow-up. PFA achieved favorable therapeutic results in patients with PFOA associated with trochlear dysplasia.

scholarly journals Good clinical outcomes of patellofemoral arthroplasty for isolated patellofemoral osteoarthritis: a case-matched cohort comparative study of PFA with TKA

2020 ◽  
Author(s):  
Fei Wang ◽  
Wei Lin ◽  
Jia Chen ◽  
Yike Dai ◽  
Jinghui Niu ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Short Form ◽  
Oxford Knee Score ◽  
Knee Score ◽  
Patellofemoral Osteoarthritis ◽  
Patellofemoral Arthroplasty ◽  
Scale Range ◽  
Activity Scale ◽  
Tegner Activity Scale

Abstract Background: Severe isolated patellofemoral osteoarthritis is usually treated by total knee arthroplasty (TKA) in the majority of the world but patellofemoral arthroplasty (PFA) has been a viable alternative for many years although there have been concerns about implant longevity. The purpose of this research was to compare the clinical outcome of patients with isolated patellofemoral osteoarthritis who received PFA or TKA. Methods: From January 2015 to December 2017, 42 patients with isolated patellofemoral osteoarthritis who received PFA were included in the PFA group. In this period, a matched cohort of 42 patients with isolated patellofemoral osteoarthritis who received TKA (TKA group) was chosen for comparison. The results of the two groups were compared before surgery and at last follow-up using Tegner Activity Scale, Range of motion of the knee, Oxford Knee Score and Short Form 36 Health Survey. Differences were considered statistically significant at p < 0.05.Results: The mean follow-up time was 3.5 ± 0.3 and 3.4 ± 0.3 years in the PFA and TKA groups (p = 0.13), respectively. No significant difference in preoperative knee scores were found between the two groups (p > 0.05). However, postoperative, compared with Tegner Activity Scale, Range of motion, Oxford Knee Score and Short Form 36 Health Survey, the PFA group performed significantly better results (p < 0.05). The Kaplan-Meier implant survivorship with 95% confidence intervals was 94.12 % in the PFA group and 94.74% in the TKA group (p = 0.49).Conclusions: The patients with isolated patellofemoral osteoarthritis who underwent PFA had shown better clinical outcomes and higher quality of life. We believed that for the treatment of isolated patellofemoral osteoarthritis, the PFA was a less invasive procedure with improved patient satisfaction and range of motion at medium term follow-up.

scholarly journals The effects of a non-operative multimodal programme on osteoarthritis of the knee

2010 ◽  
Vol 92 (6) ◽  
pp. 467-471 ◽  
Author(s):  
Shelain Patel ◽  
Fahad S Hossain ◽  
Bruce Paton ◽  
Fares S Haddad
Keyword(s):  
Effect Size ◽  
Scoring System ◽  
Oxford Knee Score ◽  
Womac Score ◽  
Osteoarthritis Of The Knee ◽  
Knee Score ◽  
Post Intervention ◽  
Patient Reported ◽  
The Mean

INTRODUCTION The purpose of this study was to determine if a multimodal programme including physiotherapy and education could improve the symptoms of osteoarthritis of the knee across various severities of disease. PATIENTS AND METHODS Seventy-two patients with osteoarthritis of the knee confirmed on radiographic evidence were referred over a 13-month period for a lower limb programme which consisted of 12 classes over 6 weeks of group physiotherapy and included education on osteoarthritis, diet and exercise. Six patients went on to have joint arthroplasty at a mean time of 6.5 months with three placed on the waiting list during follow-up. RESULTS Pre-intervention, the mean WOMAC score was 42.0 and the mean Oxford Knee Score was 32.8. Post-intervention at a mean follow-up of 12 months, the mean WOMAC score was 31.6 and the mean Oxford Knee Score 24.3. The change in scores following intervention was statistically significant (P < 0.01). Using the WOMAC scoring system, the greatest effect size was seen in patients with Kellgren–Lawrence grade IV whilst using the Oxford knee scoring system, the greatest effect size was seen in patients with Kellgren–Lawrence grade II. CONCLUSIONS At 12 months, a multimodal programme of non-operative interventions has an excellent impact upon the symptoms of osteoarthritis of the knee with improved patient-reported scores. The level of improvement cannot be inferred from the radiographic grade of osteoarthritis. This modality could be considered for all patients with mild-to-moderate osteoarthritis of the knee.

Patient-Reported Outcomes and Risk Factors for Decreased Improvement after Patellofemoral Arthroplasty

2021 ◽  
Author(s):  
Yike Dai ◽  
Naicheng Diao ◽  
Wei Lin ◽  
Guangmin Yang ◽  
Huijun Kang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patient Reported Outcomes ◽  
Trochlear Dysplasia ◽  
Oxford Knee Score ◽  
Patella Alta ◽  
Patellofemoral Arthroplasty ◽  
Duration Of Symptoms ◽  
Concomitant Surgery ◽  
Kujala Score ◽  
Patient Reported

AbstractPatellofemoral arthroplasty (PFA) is acknowledged as the method for the treatment of isolated patellofemoral osteoarthritis (PFOA). Few previous studies have assessed the patient-reported outcomes (PROs) and risk factors of less improvement of PROs in patients undergoing PFA. A retrospective analysis was performed, including all patients who had undergone PFA. Pre- and postoperative PROs included the Oxford Knee Score (OKS) and Kujala score. Univariate and multivariate statistical analyses were performed to assess influencing factors of less improvement of PROs including the demographic factors (gender, age, body mass index, smoking, opioid usage, and duration of symptoms [DOSs]), surgical factors (concomitant surgery), and imaging factors (trochlear dysplasia [TD], patellar height, the degree of PFOA). A total of 46 PFAs were analyzed with a mean follow-up of 37 ± 7 months. The mean age at surgery was 61.1 ± 7.7 years. Patients showed significant improvement in all PROs (p < 0.001). Patients with TD preoperatively have greater improvement in OKS and Kujala score postoperatively (19.2 ± 5.0 vs. 23.1 ± 3.6, p = 0.038). Longer DOSs (≥1 year) had a greater mean improvement in OKS and Kujala score (p = 0.011 and p = 0.000). According to the measurement of patella height, patients with patella alta (Caton–Deschamps index [CDI] ≥1.3) showed less improvement in both OKS and Kujala score (p = 0.000 and p = 0.002). PFA is a safe and efficient surgery with good PROs. Patella alta with a CDI ≥1.3 and duration of preoperative symptoms ≤ 1 year were risk factors for decreased OKS and Kujala score improvement, while the preoperative presence of TD was significantly predictive factors for increased OKS improvement.

scholarly journals The short-term effectiveness and safety of second-generation patellofemoral arthroplasty and total knee arthroplasty on isolated patellofemoral osteoarthritis: a systematic review and meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Chengxin Li ◽  
Zhizhuo Li ◽  
Lijun Shi ◽  
Fuqiang Gao ◽  
Wei Sun
Keyword(s):  
Total Knee Arthroplasty ◽  
Los Angeles ◽  
Knee Arthroplasty ◽  
Second Generation ◽  
Oxford Knee Score ◽  
Patellofemoral Osteoarthritis ◽  
Patellofemoral Arthroplasty ◽  
Ucla Activity Score ◽  
Patient Reported ◽  
Total Knee

Abstract Background We aimed to compare second-generation patellofemoral arthroplasty (2G PFA) with total knee arthroplasty (TKA) in treating isolated patellofemoral osteoarthritis (PFOA) by assessing the percentages of revisions, complications, and patient-reported outcome measures (PROMs). Methods Studies that compared the outcomes of 2G PFA and TKA in the treatment of isolated PFOA were searched in electronic databases, including MEDLINE, Embase, and Web of Science. Two researchers independently identified eligible studies, extracted the data, and evaluated the quality of the literature. Pooled risk ratios (RRs) or weighted mean differences with 95% confidence intervals were calculated using either fixed or random effects models. Descriptive analysis was used when data could not be pooled. Results A total of six studies were included in the review. For the revision percentage and complications, there were no significant differences between 2G PFA and TKA (RR = 2.29, 95% CI 0.69–7.58, P = 0.17; RR = 0.56, 95% CI 0.23–1.40, P = 0.22, respectively). Second, the results demonstrated that the differences in the Oxford Knee Score (OKS) and the University of California, Los Angeles (UCLA) activity score between 2G PFA and TKA were not significant (WMD −4.68, 95% CI −16.32 to 6.97, p = 0.43; WMD 0.16, 95% CI −1.21 to 1.53, P = 0.82). The Knee Injury and Osteoarthritis Outcome Score (KOOS), the American Knee Society Score (AKSS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were presented in a narrative form due to methodological heterogeneity. Conclusion For isolated PFOA, 2G PFA demonstrated similar results to TKA with respect to the percentages of revisions, complications, and PROMs.

The effect of surgery in tenosynovial giant cell tumours as measured by patient-reported outcomes on quality of life and joint function

2019 ◽  
Vol 101-B (3) ◽  
pp. 272-280 ◽  
Author(s):  
F. G. M. Verspoor ◽  
M. J. L. Mastboom ◽  
G. Hannink ◽  
W. T. A. van der Graaf ◽  
M. A. J. van de Sande ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Giant Cell ◽  
Diffuse Type ◽  
Joint Function ◽  
Population Means ◽  
Sf 36 ◽  
Patient Reported ◽  
The Impact

Aims The aim of this study was to evaluate health-related quality of life (HRQoL) and joint function in tenosynovial giant cell tumour (TGCT) patients before and after surgical treatment. Patients and Methods This prospective cohort study run in two Dutch referral centres assessed patient-reported outcome measures (PROMs; 36-Item Short-Form Health Survey (SF-36), visual analogue scale (VAS) for pain, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)) in 359 consecutive patients with localized- and diffuse-type TGCT of large joints. Patients with recurrent disease (n = 121) and a wait-and-see policy (n = 32) were excluded. Collected data were analyzed at specified time intervals preoperatively (baseline) and/or postoperatively up to five years. Results A total of 206 TGCT patients, 108 localized- and 98 diffuse-type, were analyzed. Median age at diagnosis of localized- and diffuse-type was 41 years (interquartile range (IQR) 29 to 49) and 37 years (IQR 27 to 47), respectively. SF-36 analyses showed statistically significant and clinically relevant deteriorated preoperative and immediate postoperative scores compared with general Dutch population means, depending on subscale and TGCT subtype. After three to six months of follow-up, these scores improved to general population means and continued to be fairly stable over the following years. VAS scores, for both subtypes, showed no statistically significant or clinically relevant differences pre- or postoperatively. In diffuse-type patients, the improvement in median WOMAC score was statistically significant and clinically relevant preoperatively versus six to 24 months postoperatively, and remained up to five years’ follow-up. Conclusion Patients with TGCT report a better HRQoL and joint function after surgery. Pain scores, which vary hugely between patients and in patients over time, did not improve. A disease-specific PROM would help to decipher the impact of TGCT on patients’ daily life and functioning in more detail. Cite this article: Bone Joint J 2019;101-B:272–280.

Robotic-Assisted Patellofemoral Replacement—Correlation of Preoperative Planning with Intraoperative Implant Position and Early Clinical Experience: A Minimum 2-Year Follow-up

2020 ◽  
Author(s):  
Veenesh Selvaratnam ◽  
Andrew Cattell ◽  
Keith S. Eyres ◽  
Andrew D. Toms ◽  
Jonathan R. P. Phillips ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Preoperative Planning ◽  
Trochlear Dysplasia ◽  
Oxford Knee Score ◽  
Implant Position ◽  
Robotic Assisted ◽  
Implant Positioning ◽  
Flexion Extension ◽  
The Mean

AbstractPatello-femoral arthroplasty (PFA) is successful in a selected group of patients and yields a good functional outcome. Robotic-assisted knee arthroplasty has been shown to provide better implant positioning and alignment. We aim to report our early outcomes and to compare Mako's (Robotic Arm Interactive Orthopaedic System [RIO]) preoperative implant planning position to our intraoperative PFA implant position. Data for this study was prospectively collected for 23 (two bilateral) patients who underwent robotic-assisted PFA between April 2017 and May 2018. All preoperative implant position planning and postoperative actual implant position were recorded. Presence of trochlear dysplasia and functional outcome scores were also collected. There were 17 (two bilateral) female and 6 male patients with a mean age of 66.5 (range: 41–89) years. The mean follow-up period was 30 (range: 24–37) months. Eighteen knees (72%) had evidence of trochlear dysplasia. The anterior trochlear line was on average, 7.71 (range: 3.3–11.3) degrees, internally rotated to the surgical transepicondylar axis and on average 2.9 (range: 0.2–6.5) degrees internally rotated to the posterior condylar line. The preoperative planning range was 4-degree internal to 4-degree external rotation, 4-degree varus to 6-degree valgus, and 7-degree flexion to 3-degree extension. The average difference between preoperative planning and intraoperative implant position was 0.43 degrees for rotation (r = 0.93), 0.99 degrees for varus/valgus (r = 0.29), 1.26 degrees for flexion/extension (r = 0.83), and 0.34 mm for proudness (r = 0.80). Six patients (24%) had a different size component from their preoperative plan (r = 0.98). The mean preoperative Oxford Knee Score (OKS) was 16 and the mean postoperative OKS was 42. No patient had implant-related revision surgery or any radiological evidence of implant loosening at final follow-up. Our early results of robotic PFA are promising. Preoperative Mako planning correlates closely with intraoperative implant positioning. Longer follow-up is needed to assess long-term patient outcomes and implant survivorship.

scholarly journals Sulcus-Deepening Trochleoplasty for Trochlear Dysplasia

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110111
Author(s):  
Anthony J. Ignozzi ◽  
Zane Hyde ◽  
Scott E. Dart ◽  
David R. Diduch
Keyword(s):  
Patient Satisfaction ◽  
Trochlear Dysplasia ◽  
Recurrent Dislocation ◽  
Trochlear Groove ◽  
Thick Shell ◽  
Absorbable Sutures ◽  
Postoperative Dislocation ◽  
A Prospective Study ◽  
Patellar Stability

Background: Patients who are refractory to initial management of trochlear dysplasia, which consists of bracing and physical therapy, may be candidates for trochleoplasty. Indications: Indications for trochleoplasty include Dejour classification type B or D trochlear dysplasia, supratrochlear spur height ≥7 mm, and a positive J sign on examination. Technique Description: The thick shell sulcus-deepening trochleoplasty technique involves removing the supratrochlear spur by creating a 5-mm–thick osteochondral shell with underlying cavity, dividing the thick shell into medial and lateral leaflets, and securing the leaflets with absorbable sutures. This establishes a new trochlear groove that is flush with the anterior cortex of the femur. Results: A review of 21 studies with length of follow-up from 8.8 months to 15 years found postoperative dislocation was present in 0% to 15% of patients and the patient satisfaction ranged from 81.0% to 94.4%. A prospective study with a minimum 2-year follow-up found no cases of recurrent dislocation, no progression of radiographic arthritis, 84.8% of patients returned to sport, and the patient satisfaction was a 9.1/10. Discussion/Conclusion: Sulcus-deepening trochleoplasty for trochlear dysplasia provides patellar stability and excellent patient satisfaction.

scholarly journals A comparison between laterally wedged insoles and ankle-foot orthoses for the treatment of medial osteoarthritis of the knee: A randomized cross-over trial

2021 ◽  
pp. 026921552199363
Author(s):  
Martin Schwarze ◽  
Leonie P Bartsch ◽  
Julia Block ◽  
Merkur Alimusaj ◽  
Ayham Jaber ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Controlled Trial ◽  
Oxford Knee Score ◽  
Knee Adduction Moment ◽  
Osteoarthritis Of The Knee ◽  
Knee Score ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Patient Reported ◽  
Angular Impulse

Objective: To compare biomechanical and clinical outcome of laterally wedged insoles (LWI) and an ankle-foot orthosis (AFO) in patients with medial knee osteoarthritis. Design: Single-centre, block-randomized, cross-over controlled trial. Setting: Outpatient clinic. Subjects: About 39 patients with symptomatic medial knee osteoarthritis. Interventions: Patients started with either LWI or AFO, determined randomly, and six weeks later changed to the alternative. Main measures: Change in the 1st maximum of external knee adduction moment (eKAM) was assessed with gait analysis. Additional outcomes were other kinetic and kinematic changes and the patient-reported outcomes EQ-5D-5L, Oxford Knee Score (OKS), American Knee Society Clinical Rating System (AKSS), Hannover Functional Ability Questionnaire – Osteoarthritis and knee pain. Results: Mean age (SD) of the study population was 58 (8) years, mean BMI 30 (5). Both aids significantly improved OKS (LWI P = 0.003, AFO P = 0.001), AKSS Knee Score (LWI P = 0.01, AFO P = 0.004) and EQ-5D-5L Index (LWI P = 0.001, AFO P = 0.002). AFO reduced the 1st maximum of eKAM by 18% ( P < 0.001). The LWI reduced both maxima by 6% ( P = 0.02, P = 0.03). Both AFO and LWI reduced the knee adduction angular impulse (KAAI) by 11% ( P < 0.001) and 5% ( P = 0.05) respectively. The eKAM (1st maximum) and KAAI reduction was significantly larger with AFO than with LWI ( P = 0.001, P = 0.004). Conclusions: AFO reduces medial knee load more than LWI. Nevertheless, no clinical superiority of either of the two aids could be shown.

scholarly journals Assessing responsiveness of the EQ-5D-3L, the Oxford Hip Score, and the Oxford Knee Score in the NHS patient-reported outcome measures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sujin Kang
Keyword(s):  
Outcome Measures ◽  
Knee Replacement ◽  
Oxford Knee Score ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Knee Score ◽  
Paired Data ◽  
Replacement Surgery ◽  
Patient Reported ◽  
Oxford Hip Score

Abstract Background The degree to which a validated instrument is able to detect clinically significant change over time is an important issue for the better management of hip or knee replacement surgery. This study examines the internal responsiveness of the EQ-5D-3L, the Oxford Hip Score (OHS), and the Oxford Knee Score (OKS) by various methods. Data from NHS patient-reported outcome measures (PROMs) linked to the Hospital Episodes Statistics (HES) dataset (2009–2015) was analysed for patients who underwent primary hip surgery (N = 181,424) and primary knee surgery (N = 191,379). Methods Paired data-specific univariate responsiveness was investigated using the standardized response mean (SRM), the standardized effect size (SES), and the responsiveness index (RI). Multivariate responsiveness was furthermore examined using the defined capacity of benefit score (i.e. paired data-specific MCID), adjusting baseline covariates such as age, gender, and comorbidities in the Box-Cox regression models. The observed and predicted percentages of patient improvement were examined both as a whole and by the patients' self-assessed transition level. Results The results showed that both the OHS and the OKS demonstrated great univariate and multivariate responsiveness. The percentages of the observed (predicted) total improvement were high: 51 (54)% in the OHS and 73 (58)% in OKS. The OHS and the OKS showed distinctive differences in improvement by the 3-level transition, i.e. a little better vs. about the same vs. a little worse. The univariate responsiveness of the EQ-5D-3L showed moderate effects in total by Cohen’s thresholds. The percentages of improvement in the EQ-5D-3L were moderate: 44 (48)% in the hip and 42 (44)% for the knee replacement population. Conclusions Distinctive percentage differences in patients’ perception of improvement were observed when the paired data-specific capacity of benefit score was applied to examine responsiveness. This is useful in clinical practice as rationale for access to surgery at the individual-patient level. This study shows the importance of analytic methods and instruments for investigation of the health status in hip and/or knee replacement surgery. The study finding also supports the idea of using a generic measure along with the disease-specific instruments in terms of cross-validation.

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