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• W3147413605 abstract "To the Editor, In their recent registry study, Lewis et al. [2] observed a revision risk of patellofemoral joint replacement that was more than three times higher than the reported revision risk of total knee replacement at the same time. They concluded that the consistent and alarmingly high rates of revision should create concern. To make their point, they compared the survivorship of patellofemoral joint replacement with the no-longer-used procedure of metal-on-metal (MoM) conventional hip replacement [2]. Isolated patellofemoral joint osteoarthritis is a disease entity different from generalized (tricompartmental) osteoarthritis [1]. Patients presenting with patellofemoral joint osteoarthritis generally are younger, they frequently have had previous knee surgery, and the condition often is associated with patellar instability and trochlear dysplasia, which makes treatment challenging. When comparing the revision risk of patellofemoral joint replacement with total knee replacement, it is thus more than just the procedure that is being compared. Basically, the authors compared the revision rates of two different treatments in two different knee conditions, and in two different populations. To compare the revision risk of patellofemoral joint replacement with the revision risk of large-head MoM hip replacement and noting that the high revision risk contributed to abandonment of that procedure is an interesting idea. But again, these concepts are not comparable. First, large-head MoM hip replacement failed because of problems with the implant, not because of disease progression or persistent pain. Second, there was a good alternative to large-head MoM hip replacement. The question is whether total knee replacement provides a good treatment alternative for these younger patients. The authors reported that of the 6784 patients undergoing primary patellofemoral joint replacement, 2947 (43%) were aged 54 years or younger. We agree with the authors that the high early revision risk of patellofemoral joint replacement is a reason for concern. In our opinion, the best way forward would not be to abandon the procedure altogether just because the revision risk compares unfavorably to that of dissimilar hip or knee replacement procedures, but to examine why these patients have had revision surgery. If disease progression is indeed an important reason for revision as the authors have noted (42% of revisions), then we should try to identify predictive factors and improve patient selection. And if persistent pain is a major reason for revision (17% of revisions), the question is whether patient expectations were realistic or whether the threshold for revision surgery was too low. It is well known that residual pain is common following total knee replacement, especially in young patients [3]." @default.
• W3147413605 created "2021-04-13" @default.
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• W3147413605 date "2021-04-07" @default.
• W3147413605 modified "2023-09-29" @default.
• W3147413605 title "Letter to the Editor: Short-term Revision Risk of Patellofemoral Arthroplasty is High: An Analysis From Eight Large Arthroplasty Registries" @default.
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• W3147413605 doi "https://doi.org/10.1097/corr.0000000000001717" @default.
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