Table 1.
Summary of All Included Papers
| Study | PFA/ TKA | Prosthesis | Knees (Patients)* | Age | M:F | Follow Up (Years) | Outcomes and Results | Complications and Revision |
|---|---|---|---|---|---|---|---|---|
| Ackroyd et al. [15] | PFA | Avon | 109 (85) | 68 (46-86) | 10:75 | 5.2 (5-8) | 5-year survival (revision as endpoint): 95.8% (95% CI 91.8% to 99.8%). At five years Median Bristol pain score improved from 15/40 pts (IQR 5-20) to 35 (IQR 20-40)
Median MKS from 10 (IQR 6-15) to 25 (IQR 20-29) Median OKS 18 (IQR 13-24) to 39 (24-45) Successful results (Bristol pain score of at least 20 at five years) 80% (66) of knees |
Early complications in 6 pts; delayed wound healing, post op haemarthrosis, synovial inflammation
Patellar instability requiring re-alignment in 1pt 25pts (28%) had progression on OA requiring revision in 4 knees (4.2%) No cases of deep infection, wear, loosening or fracture |
| Kooijman et al. [16] | PFA | Richards II | 56 (51) | 50 (30-77) | 27:24 | 17 (15-21) | Mean survival of 17.8 years (95% CI 16.3 to 19.4)
Mean CKSS at 15 years inc failures - 167/200 Patient subjective judgement; 86% report Good/Excellent at mean f/u of 17 years |
Early complications in 4 pts - DVT
Early MUA, arthroscopy or debridement in 18% Revision to TKR in 10 knees due to progression of OA (17.8%) at mean 15.6 years Loosening rate of 2% requiring revision |
| Tauro et al. [17] | PFA | Lubinus | 62 (48) | 66 (50-87) | 10:49 | 7.5 (1-20) | Cumulative survival at 65% at 8 years (CI 49-77)
BKS improved from 55 (29-86) to 81 (42-100) in unrevised knees Satisfactory outcome (BKS>80) in 28 of 62 knees (45%) Patient report of pain: 53% no pain, 26% mild pain, 21% moderate pain |
Revision rate of 28% (21 knees)
15 had patellar maltracking - 5 revised to TKR, and 10 to Avon PFA) Progression of arthritis in 7 knees (6.5%) 2 patellar fractures No loosening. Infection rate not stated. Authors discontinued use of prosthesis following results |
| Argenson et al. [18] | PFA | Autocentric | 66 (66) | 57 (21-82) | 26:31 | 16.2 (12-20) | Cumulative survival 58% at 16 years (including death from unrelated causes)
Knee society pain score improvement from 53.1 (43-70) to 78.5 (60-100) Knee society function score improvement from 40.6 (10-80) to 81.2 (40-100) |
Revision for progression of OA in 14 of 57 to TKA at an average of 7.3 years (1-12)
Revision for loosening in 11 of 57 |
| Mont et al. [19] | PFA | Avon | 43 (37) | 49 (27-67) | 29:8 | 7 (4-8) | Kaplan-Meier survival 95% at 5 years and 82% at 7 years
KSOS improvement from 64 (57-68) to 87 (50-100) KSFS improvement from 48 (45-50) to 82 (20-100) |
Revision for progression of OA in 2 patients at 10.5 months to TKA.
Revision for all other causes in 3 patients (all to TKA) |
| van Jonbergen et al. [20] | PFA | Richards II | 181 (157) | 52 (±14) | 59:98 | 13.3 (2-30.6) | Cumulative survival (clinical failure as endpoint) 84% at 10 years (95% CI 78%-90%) and 69% at 20 years (CI 59%-79%)
Primary diagnosis, sex, or age at time of surgery did not significantly affect survivorship. Rate of revision in obese (BMI>30 Kg/m2) higher (P=0.0.2) |
95 further surgical procedures performed on 69 knees (38%) during the follow up period; further PFA for loosening, malposition or wear in 18 (10%), Removal of prosthesis due to infection (1) or malposition (2), conversion to TKA in 23 (13%) for progression of OA and other procedures including MUA, arthroscopy or arthrotomy in 51 (28%) |
| Cartier et al. [21] | PFA | Richards II+III | 79 (70) | 60 (36-81) | 9:41 | 10 (6-16) | Cumulative survivorship 75% at 11 years
KSOS; 77% excellent, 14% fair & 9% failures. KSFS; 72% excellent, 19% fair, and 9% failures. Patients reported 47 of 59 knees as pain free and 12 knees as causing moderate or worse pain Stair climbing/descending normal in 91% |
Further surgery required in 13 knees (5 minor)
Revision for progression of OA to TKR: 8 knees Polyethylene wear: Substantial - 1, Moderate - 5 Patellar snapping in 2% |
| Odumenya et al. [22] | PFA | Avon | 50 (32) | 66 (42-88) | 9:23 | 5.3 (2-10) | Cumulative survival 100% at 5 years.
Median OKS 30.5 (IQR 22.25-44.25) |
2 Revisions in the same patient at 6-8 years due to pain and progression of OA. 11 of 50 knees showed progression of TFOA on follow up radiographs.
No loosening, infection or periprosthetic fracture |
| Sisto & Sarin [23] | PFA | Custom (CT aided design) | 25 (22) | 45 (23-51) | 6:16 | 6 (2.6-10) | Cumulative survival 100%
18 Excellent (Knee society score>90) 7 Good (Knee society 80-90) KSOS improvement from 52 (30-60) to 91 (82-96) KSFS improvement from 49 (24-76) to 89 (81 to 94) mean range of active flexion improved from 110° (85°-120°) preoperatively to 122° (110°-130°) at the time of final follow-up. |
No subsequent operations at time of latest follow up
No reports of pain during walking. No reports weakness, instability or night pain 3 Patients had anterior knee pain when ascending/descending stairs which al resolved within 6 months. No progressive radiolucent lines or other lucencies >2mm found around the implants |
| Sarda et al. [24] | PFA | Avon | 44 (40) | 62 (43-84) | 9:31 | 4.5 (3-8) | MKS improvement from 10 (5-21) to 25 (11-30)
KSFS improvement from 57 (23-95) to 85 (27-100) Patient questionnaire; 85% Excellent/Good, 12% Fair, 5% Poor |
2 revisions to TKA; 1) Progression of OA at 18months
2) Persistent pain/clicking at 3 years
No cases of deep infection |
| Mohammed et al. [25] | PFA | Lubinus, FPV and Avon | 101/91
46 Lubinus 30 FPV 25 Avon |
57 | 1:3** | 4 (0.5-8) | 73 % did very well (Authors’ own measure/statement taken to mean that these patients did not require further surgery and had no residual stiffness) | 28 patients requiring 35 operations in total (18 arthroscopic debridement, 8 lateral retinacular release, 3 tibial tuberosity transfer, 2 MUA for stiffness and 4 revision to TKA. 1 deep infection.
No mechanical failure or radiological loosening. 1 deep |
| Wagenberg et al. [26] | PFA | Autocentric | 24 (20) | 63 (38-81) | 9:15 | 4.8 (2-11) | Cumulative survival 75% at mean of 4.8 years with revision as the end point. | Additional interventions in 21 of 24 knees.
7 of 24 revised to TKA for progression of TFOA Authors abandoned use of this prosthesis. |
| Leadbetter et al. [27] | PFA | Avon | 30 (25) | 48 (25-73) | 2:23 | 2 (0.5-6) | Procedure considered successful in 25 of 30 knees (83%) by authors own criteria. The subjective outcomes for twenty-five knees were rated by the patient as good to excellent. | 17 knees reported to be occasionally mildly painful. Six knees painful with stairs only, 2 knees painful with stairs and walking.
1 failure of technique resulting in femoral notching and 4 cases of stiffness requiring MUA. 2 revisions to TKA |
| Starks et al. [28] | PFA | Avon | 37 (29) | 66 (30-82) | 8:21 | 2 (at review) | Median OKS 39 (IQR 32-44)
Median KSOS 95 (IQR 90-100) Median MKS 28 (IQR 21-30) All but on patient satisfied at the year review |
2 patients underwent further surgery - 1 patellar resurfacing and 1 patellar fracture |
| Meding et al. [29] | TKA | AGC | 33 (27) | 52 | 6:21 | 6.2 (2-12) | KSFS improvement from 55 (35-80) to 83 (45-100)
KSPS improvement from 5 (0-20) to 44 (20-50) When compared to a matched group of TCOA no significant difference in any component of KSS or range of motion. |
No revisions, re-operations, manipulations or clinical loosening. One case of 1mm radiolucency.
No clinical thrombosis or infection. |
| Laskin et al. [30] | TKA | Genesis | 48 (48) | 67 (54-85) | N/A | 7.4 (3-10) | PFOA group (A) to matched group of TCOA (B)
Patients in the PFOA group had significantly better outcomes; KSPS - 47 (A) vs 40 (B), KSS - 96 (A) vs 88 (B), ROM - 122° (A) vs 117° (B), Bipedal stair climbing - 82% (A) vs 72% (B), Rising independently - 74% (A) vs 68% (B) (All p<0.05) |
3 patients in Group A and 4 patients in Group B complained of anterior knee pain when climbing or when standing from a sitting position. Of these 7 only 1 had patellar tilt on merchant view
No other complications declared by authors. |
| Mont [31] | TKA | PCA, Duracon & IB-2 | 30 (27) | 73 (59-88) | 9:18 | 7 (4-11) | 28 Excellent (KSS>90), 1 Good (KSS 80-89) and 1 poor (KSS<70).
KSOS improvement from 50 (20-64) to 93 (67-100) KSFS improvement from 49 (20-80) to 86 (60-100) |
One patient with poor result due to patellar tendon rupture following fall.
5 reported pain during normal walking No reported clinical loosening, infection or thrombosis No reported revision or further surgical procedures |
**
Number represents value used for survival and/or statistical analysis, **Expressed as approximate ratio (exact numbers not disclosed by authors), TCOA – Tri-compartmental Osteoarthritis, TFOA – Tibiofemoral Osteoarthritis.