The impact of patellofemoral joint diseases on functional outcomes and prosthesis survival in patients undergoing unicompartmental knee arthroplasty: a systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: Patellofemoral joint (PFJ) diseases are chronic degenerative conditions that contribute to knee joint symptoms. Unicompartmental knee arthroplasty (UKA) is widely regarded as an effective treatment for knee osteoarthritis (KOA); however, its specific indications remain a subject of debate. HYPOTHESIS: Patients with PFJ disease are expected to experience outcomes post-UKA comparable to those of patients without PFJ disease. METHODS: We conducted this meta-analysis following the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A comprehensive search of PubMed, Embase, and Web of Science databases was conducted for studies examining the association between PFJ disease and UKA, including publications up to September 2024. Extracted data encompassed author, publication year, country, disease type, prosthesis type, sample size, mean patient age, gender distribution, follow-up duration, PFJ disease prevalence at surgery, diagnostic methods, and whether PFJ disease was considered a contraindication for UKA. To maintain objectivity, only studies in which PFJ diseases were visually identifiable were included in the meta-analysis. Statistical analyses were performed using Stata 15.0 and Review Manager 5.4.1. A random-effects meta-analysis was conducted to evaluate the Oxford Knee Score (OKS), Knee Society Score (KSS), flexion range of motion (ROM), Forgotten Joint Score (FJS), Tegner activity score, and prosthesis survival rate, with outcomes stratified by PFJ disease type (PFJ degeneration or patella cartilage injury). Mean differences, confidence intervals, and P values were calculated for comparisons between the PFJ disease and non-PFJ disease groups. The Methodological Index for Non-Randomized Studies (MINORS) criteria and the Newcastle-Ottawa Scale (NOS) were applied to evaluate the risk of bias. To address heterogeneity, sensitivity analyses were performed, and publication bias was assessed using funnel plots and Egger's test. RESULTS: A total of 14,866 knees from 48 relevant studies were included in this systematic review. Methodological quality was assessed using the MINORS criteria, with case series scoring 11.0/16 and cohort studies scoring 18.2/24. PFJ degeneration emerged as the most studied condition, followed by patella cartilage injury. Clinical outcomes assessments indicated that medial PFJ degeneration, anterior knee pain, patella cartilage damage, and patella baja did not significantly impact UKA outcomes or prosthesis survival. However, severe lateral PFJ degeneration, lateral patellar subluxation, lateral trochlear osteophytes, and patellar bone marrow edema did influence results. Fifteen high-quality studies were included in the meta-analysis, involving 6080 patients-1338 in the PFJ disease group and 4,742 in the non-PFJ disease group. With an average NOS score of 7.2, the studies were generally of high quality. Meta-analysis results showed no significant differences between groups in final follow-up OKS, FJS, Tegner activity score, or prosthesis survival rate. However, the PFJ disease group had lower KSS and reduced flexion ROM compared to the non-PFJ disease group. Subgroup analysis further revealed that the PFJ degeneration group scored lower than the patella cartilage injury group on OKS, KSS, and flexion ROM following UKA. CONCLUSION: In summary, PFJ disease was found to have limited impact on UKA outcomes; however, caution is recommended for cases involving severe lateral PFJ degeneration due to potential restrictions in postoperative knee function, particularly affecting flexion ROM in UKA patients.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.008 | 0.004 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".