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The Warwick patellofemoral arthroplasty trial : a randomised clinical trial of total knee arthroplasty versus patellofemoral arthroplasty in patients with severe arthritis of the patellofemoral joint

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Odumenya, M. (Michelle), McGuinness, Katie, Achten, Juul, Parsons, Nicholas R., Spalding, Tim and Costa, Matthew L.. (2011) The Warwick patellofemoral arthroplasty trial : a randomised clinical trial of total knee arthroplasty versus patellofemoral arthroplasty in patients with severe arthritis of the patellofemoral joint. BMC Musculoskeletal Disorders, Vol.12 (No.1). p. 265. ISSN 1471-2474

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Abstract

Background
Severe arthritis of the knee is a disabling condition, with over 50,000 knee replacements performed each year in the UK. Isolated patellofemoral joint arthritis occurs in over 10% of these patients with the treatment options being patellofemoral arthroplasty or total knee arthroplasty. Whilst many surgeons believe total knee arthroplasty is the 'gold standard' treatment for severe knee arthritis, patellofemoral arthroplasty has certain potential advantages. Primarily, because this operation allows the patient to keep the majority of their own knee joint; preserving bone-stock and the patients' own ligaments. Patellofemoral arthroplasty has also been recognised as a less 'invasive' operation than primary total knee arthroplasty, facilitating a more rapid recovery. There are currently no published results of randomised clinical trials comparing the two arthroplasty techniques. The primary objective of the current study is to assess whether there is a difference in functional knee scores and quality of life outcome assessments at one year post-operation between patellofemoral arthroplasty and total knee arthroplasty. The secondary objective is to assess the complication rates for both procedures.

Methods/design
Patients who are deemed suitable, by an Orthopaedic Consultant, for patellofemoral arthroplasty and medically fit for surgery are eligible to take part in this trial. The consenting patients will be randomised in a 1:1 allocation to a total knee or patellofemoral arthroplasty. The randomisation sequence will be computer generated and administered by a central independent randomisation service. Following consent, all participants will have their knee function, quality of life and physical activity level assessed through questionnaires. The assigned surgery will then be performed using the preferred technique and implant of the operating surgeon. The first post-operative assessments will take place at six weeks, followed by further assessments at 3, 6 and 12 months. At each assessment time point all complications will be recorded. In addition, community and social care services usage will be collected using a patient questionnaire at 3, 6 & 12 months. The patients will then be sent an annual postal questionnaire. The questionnaire will ask about any problems, knee pain and function following their knee arthroplasty to monitor long-term function and failure rates.

Discussion
This trial is expected to deliver results in early 2013.

Item Type: Journal Article
Subjects: R Medicine > RD Surgery
Divisions: Faculty of Medicine > Warwick Medical School
Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit
Library of Congress Subject Headings (LCSH): Patellofemoral joint -- Surgery, Arthroplasty, Total knee replacement, Arthritis -- Treatment
Journal or Publication Title: BMC Musculoskeletal Disorders
Publisher: Bio Med Central
ISSN: 1471-2474
Official Date: 23 November 2011
Volume: Vol.12
Number: No.1
Page Range: p. 265
Identification Number: 10.1186/1471-2474-12-265
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
Funder: Action Medical Research (AMR)
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URI: http://wrap.warwick.ac.uk/id/eprint/40848

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