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PFA showed significant improvement in WOMAC score at five-year follow-up, less postoperative inpatient time, better cost-effectiveness and significantly less blood loss. PFA seems to be a viable alternative to TKA for treatment of isolated PFOA in appropriately selected patients. PFA showed less postoperative inpatient time and blood loss with similar PROMs to the TKA. Moreover, it is an economically beneficial joint-preserving procedure. PFA seems to be a viable alternative to TKA for treatment of isolated PFOA in appropriately select