The Perioperative Resource Use and Effectiveness of Patellofemoral Arthroplasty Versus Total Knee Arthroplasty: A Meta-Analysis

Abstract

Objective: Patellofemoral osteoarthritis (PFOA) is a common condition that significantly affects quality of life. With advancements in modern patellofemoral arthroplasty (PFA) prostheses, a growing number of surgeons are opting for PFA to treat isolated PFOA. This meta-analysis aimed to compare the perioperative resource use and therapeutic outcomes of PFA versus total knee arthroplasty (TKA) in patients with isolated PFOA.

Methods: A literature search was conducted in PubMed, EMBASE, the Cochrane Library, and the Web of Science until November 2024. The included studies provided direct comparisons of perioperative resource use (surgical time, blood loss, and length of stay) and postoperative outcomes (patient-reported outcome measures [PROMs], quality of life, and patient satisfaction) between modern PFA and TKA in patients with isolated PFOA. The Cochrane risk of bias assessment tool was applied to randomized controlled trials, and the modified Newcastle-Ottawa Scale was used for observational studies to evaluate methodological quality and risk of bias. Data was extracted from eligible studies and combined to calculate the mean difference (MD) or pooled relative risk with a 95% confidence interval (CI).

Results: We included eight eligible studies with a mean follow-up duration of 2–10 years. Compared with TKA, modern PFA demonstrated significantly shorter surgical times (MD = −13.67 min; 95% CI: −20.47 to −6.86) and reduced perioperative blood loss. However, no significant difference was observed in hospital length of stay. Regarding PROMs, PFA showed superior functional outcomes on the Oxford Knee Score (OKS) within 2 years postoperatively (MD = −2.02; 95% CI: −3.77 to −0.26). No significant differences were found between PFA and TKA at 12-month follow-up for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score (MD = −5.68; 95% CI: −21.54 to 10.18) or total WOMAC score (MD = −6.65; 95% CI: −30.00 to 16.70). Similarly, at 24-month follow-up, no differences were observed in the University of California, Los Angeles activity score (MD = −0.02; 95% CI: −1.79 to 1.75) or final OKS (MD = −1.09; 95% CI: −6.31 to 4.14). Quality of life and patient satisfaction remained comparable between the two procedures throughout the first 2 years and final follow-up.

Conclusions: PFA demonstrates comparable efficacy to TKA in isolated PFOA, with superior early functional recovery within the first 2 years post-surgery, shorter surgical duration, and reduced blood loss. These findings suggest PFA may be a resource-efficient alternative for eligible patients.

Keywords

patellofemoral arthroplasty / patellofemoral osteoarthritis / total knee arthroplasty

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2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.