Survival of patellofemoral arthroplasty is influenced by patient characteristics, surgical factors and surgeon experience: A systematic review.
systematic_review · Level I
Where this comes from
- Record sourced from PubMed, PMID 42662646.
- Also identified by DOI 10.1002/jeo2.70868 and PMC identifier 13521518.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
While patellofemoral arthroplasty (PFA) offers advantages in preserving the tibiofemoral joint, debate remains regarding ideal patient indications and actual revision rates. The purpose of this systematic review was to identify and critically appraise comparative studies reporting survival of PFA, and to evaluate how variation in key confounding variables influences survival outcomes. Following PRISMA guidelines and PROSPERO registration, MEDLINE®, EMBASE® and Epistemonikos were searched on 23 February 2026 for comparative studies reporting PFA survival with ≥5-year follow-up. Data extracted included author, cohort size, implant type, follow-up, Kaplan-Meier survival and number at risk. Effective numbers-at-risk and survival probabilities at each event time were reconstructed to estimate the hazard ratio (HR) for revision risk between groups. Risk of bias was assessed using Joanna Briggs Institute checklists. Nine studies were included: seven retrospective clinical cohorts (1071 knees) and two registry studies (9021 knees). Registry survival was 96% at 2 years, 83%-88% at 5-6 years and 73%-76% at 10-11 years (<i>I</i> <sup>2</sup>, 38.7%). Comparative analyses from clinical studies suggested that several factors, including body mass index (BMI), patellar height, robotic assistance and surgeon experience, may influence revision risk; however, most studies found no statistically significant difference, and some were in disagreement. Survival of PFA ranges from 73% to 76% at 10-11 years, and appears to be influenced by some non-modifiable patient factors (age, BMI and patellar height), and modifiable surgical factors (robotic assistance and surgeon experience). These trends cannot be confirmed because of conflicting findings between eligible studies, which could be due to variability of follow-ups (5-30 years), differences in survival endpoints (any revision or conversion to TKA), as well as the inconsistent thresholds for age and ratios of patellar height. Level IV.