Pre-operative patella alta does not affect midterm clinical outcomes and survivorship of patellofemoral arthroplasty

Purpose: The purpose of this study was to evaluate the effect of preoperative patella alta on clinical outcomes, survivorship, and complication and reoperation rates on patellofemoral arthroplasty (PFA).

Methods: All patients who underwent PFA for isolated patellofemoral arthritis by a single surgeon at our institution were identified. Preoperative radiographs were measured by two independent observers for patellar height using the Caton Deschamps (CD), Insall-Salvati (IS), and Blackburne-Peele (BP) methods. Patients were classified as either "patella alta" or "non-patella alta" for all three measurement methods. Clinical scores including KSS Pain, KSS Function, and Tegner Activity Scores were collected pre- and post-operatively. Failure was defined as conversion to total knee arthroplasty (TKA). Clinical outcomes and survivorship were compared between patients with "patella alta" and "non-patella alta" height measurements.

Results: There were 119 patients with 153 knees (86% female) included in the study with a mean age of 55.8 years. Outcome scores improved from pre-operative to post-operative for both patella alta and non-patella alta patients for Tegner, KSS pain and KSS function scores. The mean change in Tegner scores for patella alta and non-patella alta patients were not significantly different for CD (p = 0.24), IS (p = 0.25) or BP measurements (p = 0.39). The mean change in KSS pain scores between groups were not significantly different for CD (p = 0.33) or IS measurements (p = 0.22), but was improved more significantly in patella alta patients vs non-patella alta patients (21.2 and 14.4; p = 0.02) for BP measurement. The mean change in KSS function scores between groups was not significantly different for CD (p = 0.61) IS (p = 0.90) or BP measurements (p = 0.79). The overall survivorship from conversion to total knee arthroplasty (TKA) was 94.1% at a mean follow-up time of 5.0 (SD 2.6) years. There were no significant differences in survivorship from TKA between patella alta and non-patella alta groups (CD: p = 0.72, IS: p = 0.63, BP: p = 0.66).

Conclusions: This study suggests that there are no significant differences in clinical outcome scores or survivorship from TKA between patella alta and non-patella alta patients who underwent onlay design PFA. Both patella alta and non-patella alta patients demonstrated excellent improvement in outcome scores from pre-operative to post-operative.

Level of evidence: IV.