Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Reihs, B.
Treatment Options of Osteoarthritis of the Patellofemoral Joint in Total Knee Arthroplasty and Isolated Patellofemoral Replacement: A Cumulative Analysis using Worldwide Arthroplasty Register Datasets and Clinical Studies.
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Graz Medical University; 2018. pp. 146
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Leithner Andreas
- Sadoghi Patrick
- Altmetrics:
- Abstract:
- Objective: The aim of this doctoral thesis is to assess the outcome of patellofemoral arthroplasty (PFA) with a special interest in revisions for any reason. A meta-analysis using worldwide literature as well as arthroplasty registers was performed. Additionally to worldwide literature data, register data were used. The following questions were tried to be addressed: (1) is there a significant difference between developer and independent publications? (2) Is there a significant difference between ‘first-generation trochlear-resurfacing‘, and ‚trochlear-cutting‘ PFA? Methods: A systematic search of Medline, Embase, and Central for literature data was performed. The European Arthroplasty Register homepage was screened for register data. Three annual reports of joint arthroplasty registries and 45 clinical studies on PFA, published in indexed, peer-reviewed international scientific journals, were included. In the case of multiple studies concerned with the same patient cohort, the publication with the longest follow-up was used. (1) The main outcome measure was the revision rate, which was calculated as ‘revisions per 100 component years (CY)’ for ‘revisions for any reason’ in all extracted data. Additionally, in the literature data, all ‘revision surgeries’ were evaluated. This parameter included every procedure on the knee joint that had to be performed in theatre. As statistical significance level, a factor of three was chosen. Hence, the difference between the investigated groups had to be either three times lower or three times higher to be considered as significant in this work. This criterion was chosen due to the heterogeneity of the data and is in accordance with previously published report (2,3). Secondary outcome measures were the assessment of the reasons for revision as well as the assessment of patient-based outcome measurements. viii Results: No significant difference between the investigated groups was found. After the primary implantation of PFA implants, a total of 2.22 revisions per 100 CY were observed in the worldwide literature data, which was comparable to the value in the worldwide register datasets. The difference between ‘first generation trochlear-resurfacing’ and ‘trochlear-cutting’ PFA, as well as between developer and independent publications, was not significant. (1) A separate analysis of the literature data yielded superior revision rates for ‘revision surgeries’ in comparison to ‘revisions for any reason’ which was in part due to mechanical complications, which were often successfully treated with realignment procedures. Mechanical complications were found more often in older PFA devices. 21 different patient-based outcome measurements were found in 36 publications. Due to their heterogeneity, a statistical analysis was not possible. Discussion and Conclusion: Developer publications do not seem to be biased (1). Newer devices of PFA yielded superior outcomes; however, according to the rigorous level of significance used in this study, the difference was not statistically significant. (1) The comparison between ‘revision surgeries’ and ‘revisions for any reason’ in the literature data revealed that minor complications occur more frequently; many mechanical complications could be addressed with minor revision surgeries, leaving the implant in place. A promising decrease of such revision surgeries was found in ‘trochlear-cutting’ implants, which might be due to increasing experience with PFA and due to improvements of the material. However, the follow-up times of the studies on these implants were comparably short; hence, there is still the possibility of a future change of the revision rates in this group when studies with longer follow-up times are published. On the whole, more long-term data are needed for the assessment of newer implants. The findings of worldwide literature and register data was consistent.