title: Complications after patello-femoral versus total knee replacement in the treatment of isolated patello-femoral osteoarthritis. A meta-analysis.
abstract: OBJECTIVE
  Both patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA) are successful in treating isolated patellofemoral osteoarthritis, but the complication rates after PFA are concerning. We performed a meta-analysis to compare the incidence of complications, re-operations, and revision following PFA and TKA for patellofemoral osteoarthritis.
  
  
  METHODS
  We systematically identified publications with patients who underwent PFA or TKA for patellofemoral osteoarthritis with minimum 1.5 year follow-up. Demographics, implant (TKA, first [1G] or second-generation [2G] PFA), complications, and cause of re-operations were extracted. Random-effects meta-analysis was used to pool incidence data, which was compared between groups using logistic regression to adjust for length of follow-up.
  
  
  RESULTS
  Twenty-eight observational studies and no randomized trials were included in this meta-analysis, which limits its generalizability. There was a higher likelihood of any re-operation (odds ratio 8.06) and revision (OR 8.11) in PFA compared to TKA. Re-operation (OR 4.33) and revision (OR 4.93) were more likely in 1G-PFA than 2G-PFA. When comparing 2G-PFA to TKA, there was no significant difference in re-operation, revision, pain, or mechanical complications.
  
  
  CONCLUSIONS
  Patients who undergo PFA rather than TKA are more likely to experience complications and require re-operation or revision, but subgroup analysis suggests a relation to implant design. There is no significant difference in re-operation, revision, pain, or mechanical complications between 2G-PFA and TKA.
  
  
  METHODS
  Systematic review of Level III therapeutic studies, Level III.
authors: Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA. dyc@hss.edu
authors: C J
authors: CJ
authors: Dy
authors: N
authors: N
authors: Franco
authors: Y
authors: Y
authors: Ma
authors: M
authors: M
authors: Mazumdar
authors: M M
authors: MM
authors: McCarthy
authors: A
authors: A
authors: Gonzalez Della Valle
mesh_terms: D018771:Arthralgia / Q000209:etiology; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D018450:Disease Progression; D006801:Humans; D007720:Knee Prosthesis; D020370:Osteoarthritis, Knee / Q000601:surgery*; D057071:Patellofemoral Joint / Q000601:surgery*; D012086:Reoperation