Sabbag, Casey M.

AbstractPurposeThe 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).MethodsAll 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.ResultsThere 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).ConclusionsThis 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 evidenceIV.

Background: Previous studies on periacetabular osteotomy (PAO) reported complication and reoperation rates of 5.9% and 10%, respectively. Hip arthroscopy is increasingly utilized as an adjunct procedure to PAO to precisely treat associated intra-articular pathology. The addition of this procedure has the potential of further increasing complication rates. Purpose: To determine the rates of complication and reoperation of combined hip arthroscopy and PAO for the treatment of acetabular deformities and associated intra-articular lesions. Study Design: Case series; Level of evidence, 4. Methods: Using a prospective database, the authors retrospectively reviewed 248 hips (240 patients) that underwent combined hip arthroscopy and PAO between 2007 and 2016. Data were collected at scheduled follow-up visits at approximately 1 month, 3 to 4 months, and 1 and 2 years after surgery. Mean follow-up from surgery was 3 years (range, 1-8 years). A total of 220 PAOs were done for symptomatic acetabular dysplasia, 18 for symptomatic acetabular retroversion, and 10 for combined acetabular dysplasia and acetabular retroversion. Central compartment arthroscopy was performed for treatment of intra-articular chondrolabral pathology in all cases. Select cases underwent femoral head-neck junction osteochondroplasty either arthroscopically before the PAO or through an open approach after it. Complications were graded according to the modified Dindo-Clavien complication scheme, which was validated for hip preservation procedures. Reoperations (excluding hardware removal) were recorded. Results: Grade III complications occurred among 7 patients (3%) while there were no grade IV complications. Grade III complications included deep infection (n = 3), wound dehiscence (n = 1), hematoma requiring exploration (n = 1), symptomatic heterotopic ossification requiring excision (n = 1), and deep venous thrombosis (n = 1). There were 13 reoperations (5%), and 3 were repeat hip arthroscopy. Univariate Cox hazard models were used to estimate the relative risk factors for complication and reoperation. Increased age (per decade) showed over twice the increased likelihood for complications (hazard ratio, 2.5; 95% CI, 1.67-3.74). Also, preoperative diagnosis of acetabular retroversion, not acetabular dysplasia, showed >3 times the increased risk of reoperation (hazard ratio, 3.05; 95% CI, 1.41-6.61). Conclusion: The rate of complications reported is comparable (3%) with previously published complication rates of PAO without hip arthroscopy. In this cohort, increasing age and diagnosis of acetabular retroversion were associated with higher complication and reoperation rates.