Contemporary patellofemoral arthroplasty is associated with lower revision rates compared with the previous decade: A meta-analysis using revisions per 100 component-years.

In 30 seconds

This Level IV meta-analysis assessed whether patellofemoral arthroplasty (PFA) survival has changed over the decade since an earlier analysis, using the same endpoints and registry sources. It included 15 primary studies, mostly involving contemporary onlay designs, and synthesized national registry data. The pooled random-effects revision rate was 1.59/100 component-years (95% CI = 1.24-2.04), corresponding to a 10-year revision rate of 15.9% and an absolute survivorship improvement of 6.3% versus the earlier benchmark. The authors report a more favourable contemporary survival profile, while noting predominantly critical risk of bias.

Key findings

• Across 15 studies, the pooled revision rate was 1.59/100 component-years (95% CI = 1.24-2.04), equivalent to a 10-year revision rate of 15.9%.
• Pooled survivorship improved by 6.3% in absolute terms compared with the earlier benchmark analysis.
• Registry synthesis across 117.524 CY yielded 1.85/100 CY (95% CI = 1.775-1.931), corresponding to 18.5% revision at 10 years (95% CI = 17.75-19.3).
• Heterogeneity was moderate (I 2 = 52.7%), and ROBINS-I assessment indicated predominantly critical risk of bias.

Why it matters

Revision rates provide a clinically relevant measure for counselling and evaluating PFA durability. The findings suggest that contemporary outcomes may be more favourable than estimates from the previous decade, particularly in a literature dominated by onlay designs. However, the substantial risk of bias and moderate heterogeneity mean the pooled estimates should be interpreted cautiously rather than as definitive evidence of improved outcomes for every patient or implant.

What to keep in mind

The evidence was predominantly at critical risk of bias, with moderate heterogeneity; the analysis was Level IV.