Comparing Return to Sports After Patellofemoral and Knee Arthroplasty in an Age- and Sex-Matched Cohort

Abstract

Background: Return to sports is an important outcome in ensuring patient satisfaction after knee-replacement surgery. However, few studies have directly compared unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), and patellofemoral arthroplasty (PFA). Hypothesis: TKA will result in lower rates of return to sports than either UKA and PFA due to increased complexity and invasiveness. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent UKA, TKA, or PFA with 1 to 2 years of follow-up were sent a questionnaire regarding return to sports, satisfaction with return to sports, pain, the University of California, Los Angeles activity scale, and the High Activity Arthroplasty Score (HAAS). The patients who underwent either TKA or UKA were matched 2:1 with regard to age and sex to patients who underwent PFA. Differences were compared using analysis of variance, t tests, and chi-square tests. Results: A total of 202 patients were eligible. After matching, the final cohort consisted of 23 PFA patients, 46 UKA patients, and 46 TKA patients. The majority of patients were female (87%), and the mean ± SD age was 56 ± 9.1 years. The UKA group had higher HAAS values than the TKA group pre- and postoperatively (9.9 vs 7.1 [ P = .001] and 12.4 vs 9.5 [ P < .001], respectively). Patients with UKA had higher rates of return to sports after surgery than those with TKA or PFA (UKA, 80.5%; TKA, 71.7%; PFA, 69.5%; P = 0.08). In addition, the UKA group had the highest satisfaction with this outcome. Improvement between pre- and postoperative scores was similar in all 3 groups. Conclusion: Patients who underwent UKA reported better activity scores and return-to-sports rates than patients who had TKA and PFA. No differences were found in improvement after surgery, suggesting that preoperative differences were reflected postoperatively. These findings inform shared decision making and can help to manage patient expectations after surgery.