Background:Limited data are available on return to sports and patient psychometric ratings of success after patellofemoral arthroplasty (PFA) in younger patients with high expectations to return to an active lifestyle.Purpose/Hypothesis:The purpose of this article was to determine the role of PFA and its success in meeting patient expectations regarding the return to low-impact recreational sports and an active lifestyle in younger, active patients. It was hypothesized that PFA would allow younger patients to return to low-impact sports and an active lifestyle and achieve high patient psychometric ratings.Study Design:Case series; Level of evidence, 4.Methods:In this 10-year prospective study (2009-2018), robotic-assisted PFA was performed on 44 patients (32 women and 12 men; n = 51 consecutive knees), with a mean age of 37.2 years (range, 21-50 years). The follow-up rate was 98%, with a mean of 5.3 years (range, 2-9.3 years). Primary clinical outcomes were as follows: the validated Cincinnati Knee Rating System sports activity and symptom rating scales, patient psychometric ratings of the substantial clinical benefit (SCB), and the Patient Acceptable Symptom State (PASS). Secondary outcomes were the Cincinnati Knee Rating System occupational rating, visual analog pain scale, and the 12-Item Short Form Health Survey. Survivorship was defined by conversion to total knee replacement (TKR).Results:Before PFA, 78% of patients (35/45 knees) were symptomatic and unable to perform recreational sports, with only 20% of patients (9/45 knees) performing some low-impact sports. After PFA, 80% of patients (36/45 knees) were able to perform low-impact sports, and 7% (3/45 knees) performed jumping-pivoting sports ( P < .001). The SCB scored by the patient showed 87% of knees as good, very good, or normal. On the PASS analysis, 89% of patients (95% CI, 76%-96%) were “pleased,” and 93% (95% CI, 82%-99%) would undergo surgery again. There were clinically relevant improvements in symptoms of pain, swelling, and giving way ( P = .0001). Preoperatively, 91% of knees had moderate to severe pain with activities of daily living, and only 11% of knees had pain at the follow-up. Five of the 50 knees (10%) underwent TKR conversion with one patient lost to follow-up.Conclusion:PFA resulted in a high return of patients to low-impact sports with high SCB and PASS psychometric ratings. The robotic-assisted 3-dimensional preoperative planning allowed precise intraoperative trochlear implant alignment in knees with severe trochlear dysplasia. PFA is recommended as an alternative treatment in younger patients with end-stage symptomatic patellofemoral arthritis.Registration:NCT02738476 (ClinicalTrials.gov identifier).

中文翻译：

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机器人辅助髌股关节置换术后 50 岁或以下患者恢复运动：10 年经验报告恢复积极生活方式带来的高临床效益和高患者满意度

背景：对于希望恢复积极生活方式的年轻患者来说，关于髌股关节置换术 (PFA) 后恢复运动和患者心理测量成功率的数据有限。 目的/假设：本文的目的是确定PFA 及其成功满足了患者对年轻、活跃患者恢复低影响休闲运动和积极生活方式的期望。据推测，PFA 将使年轻患者恢复低影响运动和积极的生活方式，并获得较高的患者心理测量评级。研究设计：案例系列；证据级别，4。方法：在这项为期 10 年的前瞻性研究（2009-2018）中，对 44 名患者（32 名女性和 12 名男性；n = 51 个连续膝盖）进行了机器人辅助 PFA，平均年龄为 37.2 岁年（范围，21-50 岁）。随访率为98%，平均5.3年（范围2-9.3年）。主要临床结果如下：经过验证的辛辛那提膝关节评定系统运动活动和症状评定量表、患者对实质性临床获益（SCB）的心理测量评定以及患者可接受的症状状态（PASS）。次要结果是辛辛那提膝关节评级系统职业评级、视觉模拟疼痛量表和 12 项简短健康调查。存活率的定义是转为全膝关节置换术 (TKR)。 结果：在 PFA 之前，78% 的患者（35/45 膝）出现症状且无法进行休闲运动，只有 20% 的患者（9/45 膝）能够进行休闲运动一些低影响的运动。 PFA 后，80% 的患者（36/45 膝）能够进行低冲击运动，7%（3/45 膝）能够进行跳跃旋转运动 (P < .001)。患者的 SCB 评分显示 87% 的膝盖为良好、非常良好或正常。在 PASS 分析中，89% 的患者（95% CI，76%-96%）表示“满意”，93%（95% CI，82%-99%）将再次接受手术。疼痛、肿胀和屈服症状有临床相关的改善 (P = .0001)。术前，91%的膝盖在日常生活活动中出现中度至重度疼痛，而随访时只有11%的膝盖出现疼痛。 50 个膝关节中有 5 个（10%）接受了 TKR 转换，其中 1 名患者失访。结论：PFA 导致患者大量回归低冲击运动，且 SCB 和 PASS 心理测量评级较高。机器人辅助的 3 维术前规划可以在患有严重滑车发育不良的膝盖中实现精确的术中滑车植入物对准。 PFA 被推荐作为患有终末期症状性髌股关节炎的年轻患者的替代治疗。注册：NCT02738476（ClinicalTrials.gov 标识符）。