Background

Patellofemoral arthroplasty (PFA) for isolated patellofemoral osteoarthritis (OA) remains controversial due to variable postoperative outcomes and high failure rates. Second-generation (2G) onlay prostheses have been associated with improved postoperative outcomes. This systematic review was performed to assess the current overall survivorship and functional outcomes of 2G PFA.

Methods

A search was performed using PubMed, Cochrane Library, EMBASE and Google Scholar. Thirty-three studies published in the last 15 years (2005-2020) were included, of these twenty-two studies reported patient reported outcome measures (PROMs). Operative and non-operative complications were analyzed. Pooled statistical analysis was performed for survivorship and functional scores using Excel 2016 and Stata 13.

Results

The mean age of the patients was 59.7. When analyzing all studies, weighted survival at mean follow up of 5.52 was 87.72%. Sub-analysis of studies with minimum 5 years follow up showed a survival of 94.24%. Fifteen studies reported OKS with a weighted mean postoperative OKS of 33.59. Mean AKSS pain was 79.7 while mean AKKS function was 79.3. The most common operative complication was OA progression for all implants. The percentage of revisions and conversions reported after analyzing all studies was 1.37 % and 7.82% respectively.

Conclusion

Safe and acceptable results of functional outcomes and PFA survivorship can result from 2G PFAs at both short and mid-term follow-up for patients with isolated patellofemoral OA. However, long term follow-up outcomes are still pending for the newer implants. More extensive studies using standardized functional outcomes and long-term cost benefits should be evaluated.