Journal of Knee Surgery最新文献

{"title":"Survivorship of Primary NexGen Knee Replacement: Comparing Cementless Trabecular Metal to Other Designs of Tibial Component.","authors":"Ayooluwa S Ayoola, Michael A Charters, Hamza M Raja, Luke Weseman, Peter L Lewis, Yi Peng, Wayne Trevor North","doi":"10.1055/a-2376-6889","DOIUrl":"10.1055/a-2376-6889","url":null,"abstract":"<p><p>The impact of cementless trabecular metal (TM) implants on implant survivorship are not well delineated. This study compares primary total knee arthroplasty (TKA) revision rates of cemented knee replacements with two cementless knee replacement designs-cementless TM and a non-TM cementless design. Data from a national registry queried TKA procedures performed for osteoarthritis from 1999 to 2020. The risk of revision of Zimmer NexGen TKA using cementless TM, cementless non-TM, and cemented non-TM were compared. Analyses included Kaplan-Meier estimates of survivorship and Cox hazard ratios (HR), stratified by age and gender. Cementless TM components had higher risks of revision compared with cementless non-TM implants (HR = 1.49; <i>p</i> ≤ 0.001). Cementless TM implants showed higher risks of revision compared with cemented non-TM prostheses for the first 2 years (HR = 1.75, <i>p</i> < 0.001). Non-TM prostheses posed equal risk of revision for cementless and cemented fixations (HR = 0.95, <i>p</i> = 0.522). Patients aged 55 to 64 years and 65 to 74 years had a higher risk of revision for cementless TM compared with cementless non-TM (HR = 1.40, <i>p</i> = 0.033 and HR = 1.79, <i>p</i> < 0.001, respectively) and cemented non-TM implants (HR = 1.51, <i>p</i> < 0.001 and HR = 1.54, <i>p</i> < 0.001, respectively). The study shows there is an increased risk of revision with TM cementless implants for patients aged 55 to 74 years. These results do not support the use of TM tibial implants for patients of this age group for primary TKA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"949-958"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Joint Laxity on 2-Year KOOS Outcomes of Posterior Stabilized Total Knee Arthroplasty.","authors":"Amber L Randall, Edgar A Wakelin, James Kah, John M Keggi, Jan A Koenig, Jeffrey H DeClaire, Corey E Ponder, Jeffrey M Lawrence, Christopher Plaskos","doi":"10.1055/a-2376-7085","DOIUrl":"10.1055/a-2376-7085","url":null,"abstract":"<p><p>The objective of this study was to determine relationships between intraoperative posterior cruciate ligament (PCL) sacrificing posterior stabilized (PS) total knee arthroplasty (TKA) laxity measurements throughout flexion and patient outcomes at 2 years post-TKA and to define clinically relevant laxity thresholds to optimize patient outcomes.In a single-surgeon study, PCL sacrificing TKA using a robotics-assisted platform with a digital joint tensioning device was performed in 115 knees in 115 patients. Final intraoperative joint laxity was recorded, and 2-year Knee Injury and Osteoarthritis Outcome Scores (KOOSs) were obtained. A Simulated Annealing optimization algorithm was used to identify medial and lateral laxity windows which maximized the 2-year KOOS pain score. Wilcoxon nonparametric tests were used to compare outcomes between groups.Significant associations were found between intraoperative joint laxity and 2-year KOOS pain outcomes throughout flexion. Clinically relevant laxity windows were defined medially and laterally in mid-flexion and flexion for improved outcomes, whereas only a lateral laxity window could be defined in extension. When all laxity windows were satisfied, a 14.5-KOOS point improvement was found (97.2 vs. 77.8, <i>p</i> = 0.0060) compared to knees which did not satisfy any window. Improvements in Activities of Daily Living (Δ8.8, <i>p</i> = 0.0143), Sports (Δ22.5, <i>p</i> = 0.0108), and Quality of Life (Δ18.7, <i>p</i> = 0.0011) KOOS subscores were also found in knees which satisfied all windows versus 0-1 window.Intraoperative joint laxity is associated with postoperative outcomes in a PS knee design, wherein patients balanced within identified laxity targets reported improved outcomes over those that did not. Clinically significant thresholds were defined and were predominately found in mid-flexion and flexion for medial and lateral laxity. When target windows were combined further improved outcomes were identified.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"941-948"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Articular Cartilage Damage in the Patellofemoral Compartment at ACL Reconstruction Predicts Poor Postoperative Subjective Outcomes in Patients Age 40 and Older.","authors":"Ayato Miyamoto, Atsuo Nakamae, Kazuhiro Tsukisaka, Masataka Deie, Eisaku Fujimoto, Yoshinori Soda, Ryo Shimizu, Nobuo Adachi","doi":"10.1055/a-2368-3739","DOIUrl":"10.1055/a-2368-3739","url":null,"abstract":"<p><p>The purpose of this study was to investigate factors that influence clinical outcomes after anterior cruciate ligament (ACL) reconstruction in patients aged ≥40 years. We studied 264 patients aged ≥40 and 154 patients aged ≤20 years who underwent ACL reconstruction at several surgical centers. A logistic regression analysis was conducted to identify factors that influenced the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 1 year post-ACL reconstruction. In the older patient group, cartilage damage in the patellofemoral compartment at surgery was a significant risk factor for poor postoperative KOOS subscores (pain, activities of daily living [ADL], sports, and quality of life [QOL]). Articular cartilage damage in the lateral compartment also significantly influenced one of the postoperative KOOS subscores (symptoms). In the younger patient group, articular cartilage damage in any compartments did not influence the postoperative KOOS subscores; only two preoperative KOOS subscores (symptoms and QOL) significantly influenced their postoperative KOOS subscores. We concluded that the articular cartilage damage in the patellofemoral compartment at ACL reconstruction predicts poor KOOS subscores at the 1-year follow-up in patients aged ≥40 years. STUDY DESIGN:  Cohort study (Prevalence); Level of evidence, 2.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"925-932"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survey Results Concerning Current Trends in Meniscus Repair Indications and Preferences from Members of the Pediatric Research in Sports Medicine (PRiSM) Society.","authors":"J Lee Pace, John A Schlechter, Brian Haus, Rong Huang","doi":"10.1055/a-2368-4049","DOIUrl":"10.1055/a-2368-4049","url":null,"abstract":"<p><p>Meniscus repair has increased in frequency, especially among surgeons who focus on youth sports injuries. The aim of this study was to determine current trends in meniscus repair among a specific subset of meniscus repair surgeons. A cross-sectional survey utilizing several clinical vignettes was administered to orthopaedic surgeon members of the Pediatric Research in Sports Medicine (PRiSM) Society to investigate surgeon experience and training, number of meniscus repair procedures performed, and surgical and rehabilitation preferences. A statistical analysis of the responses was performed to determine associations between years in practice or type of fellowship training and the number of meniscus repair procedures performed, surgical indications, and rehabilitation preferences. The response rate to various questions ranged from 61.5 (59/96) to 63.5% (61/96). In all vignettes, a majority favored repair as well as some degree of weight-bearing and range-of-motion restrictions. Surgeons who had been in practice for 6 to 10 years performed significantly more meniscus repairs per year than those who had been in practice for greater than 20 years (<i>p</i> = 0.009) and those who had been in practice for 0 to 5 years (<i>p</i> = 0.05). Surgeons who had been in practice for greater than 20 years performed a significantly higher percentage of meniscectomies relative to meniscus repairs, compared with those in practice for 0 to 5 years (<i>p</i> = 0.002) or 6 to 10 years (<i>p</i> = 0.0003). When surgeons were grouped into those with less than 10 years of experience and those with greater than 10 years of experience, the former group performed a significantly higher number of meniscus repairs relative to meniscectomies than the latter group of surgeons (<i>p</i> < 0.0001). Less experienced surgeons are more likely to perform meniscus repair than meniscectomy, but all surgeons surveyed had a general preference for repair in all clinical vignettes. Repair technique preferences as well as rehabilitation protocols varied widely among surgeons.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"933-940"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interatrial Wall Abnormality is Associated with Adverse Same-Admission Outcomes Following Total Knee Arthroplasty.","authors":"Bruce B Zhang, Abdullah A Uddin, David H Mai, Declan Tozzi, Adam J Wolfert, Qais Naziri","doi":"10.1055/a-2376-6810","DOIUrl":"10.1055/a-2376-6810","url":null,"abstract":"<p><p>Total knee arthroplasty (TKA) is the most common joint arthroplasty procedure and is shown to be a reliable and efficacious way to improve quality of life. Individuals with interatrial wall abnormalities (IAWAs), such as atrial septal defect or patent foramen ovale (PFO), are at increased baseline risk for stroke and overall lifetime morbidity. The purpose of our study was to elucidate the association between IAWAs and perioperative TKA outcomes.We performed a retrospective cohort study utilizing the Healthcare Cost and Utilization Project National Inpatient Sample database. Admissions for TKA between 2010 and 2019 were identified using the international classification of disease (ICD)-9 and ICD-10 procedure codes. Patients with ICD-9-clinical modification (CM) diagnosis code 7455 or ICD-10-CM diagnosis code Q211 were assigned to the IAWA cohort, the primary exposure. Confounding variables included basic demographics, baseline health status, and surgical facility characteristics. The primary outcomes studied were medical complications, implant-related complications, and admission mortality. Univariate and adjusted multivariable regression analyses were used to identify associations.Compared to patients in the non-IAWA cohort, those in the IAWA cohort had significant risks for same-admission medical complications (odds ratio [OR] 5.77, 95% confidence interval [CI] 4.59-7.15; <i>p</i> < 0.001), implant-related complications (OR 1.55, 95% CI 1.09-2.12; <i>p</i> = 0.009), stroke (OR 77.46, 95% CI 58.4-101.2; <i>p</i> < 0.001), venous thromboembolism (VTE; OR 3.78 95% CI 2.47-5.51; <i>p</i> < 0.001), and mortality (OR 8.36, 95% CI 3.54-16.52; <i>p</i> < 0.001) following TKA.Compared to patients without IAWAs, those with IAWAs who undergo TKA have higher risks for same-admission medical and implant-related complications as well as same-admission mortality. Similarly, these patients have higher risks for same-admission stroke and VTE. Further research on perioperative TKA management in patients with IAWAs is needed.Level of Evidence is III: retrospective cohort study.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"966-972"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Traditional Intramedullary Axis Underestimates the Medial Tibial Slope Compared to Transmalleolar Sagittal Axis in Image-based Robotic-Assisted Unicompartimental Knee Arthroplasty.","authors":"Mattia Chirico, Luigi Zanna, Mustafa Akkaya, Christian Carulli, Roberto Civinini, Matteo Innocenti","doi":"10.1055/a-2376-6999","DOIUrl":"10.1055/a-2376-6999","url":null,"abstract":"<p><p>The medial unicompartmental knee arthroplasty (mUKA) has been recognized as an excellent treatment for medial knee osteoarthritis. The posterior tibial slope (PTS) is measured radiographically with the intramedullary axis (IMA) to the tibial baseplate on the sagittal plane radiograph. However, in most computer-navigated or robotic mUKAs, the PTS is set from a transmalleolar axis (TMA).The PTS difference was evaluatedbetween the sagittal TMA and the sagittal IMA of patients undergoing a CT-based primary robotic-assisted mUKA.We retrospectively reviewed the preoperative computed tomography (CT) scans taken according to the MAKO system protocol (Stryker) of 67 patients undergoing mUKAs. We measured the angular difference between the IMA and the TMA in the sagittal plane.Using the TMA to set the PTS the estimation of the slope of the medial tibial plateau would increase by an average of 1.9 ± 3.2 degreescompared to the IMA. Furthermore, in nineknees, PTS was decreased.Tibial components implanted with the help of a CT scan-based preoperative planning MAKO will show an average of 1.9 degrees more than those measured on sagittal radiographs potentially of concern for knee kinematics. A universal language is needed to standardize the slope calculation and the respective reference axis used.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"959-965"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic Assessment of Total Knee Arthroplasty Alignment with and without Accelerometer-Based Navigation at a Resident Training Institution.","authors":"Brett G Brazier, Christian Bryce Allen, Daryl Hillyard, Darshan Shah, David Vizurraga, Donald Hope","doi":"10.1055/a-2481-8647","DOIUrl":"https://doi.org/10.1055/a-2481-8647","url":null,"abstract":"<p><strong>Introduction: </strong>Malalignment and lack of surgeon experience are cited as risk factors for prosthetic failure and the need for subsequent revision surgery in total knee arthroplasty (TKA). Various Conventional (CON) and Computer Assisted Surgical (CAS) methods have been developed to try and prevent malalignment and limit outliers. One of these methods is through an accelerometer-based CAS (aCAS) which intra-operatively helps determine the angulation and amount of resection necessary to restore alignment in TKA. The purpose of this study was to determine the number of TKA alignment outliers in TKA's performed both with CON and aCAS methods at a single training institution in cases that trainees were involved in.</p><p><strong>Methods: </strong>In this retrospective single center study, radiographic analysis of 150 primary TKAs performed at our training institution was performed. The medial distal femoral angle (DFA), medial proximal tibial angle (PTA), and posterior slope angle (PSA) were evaluated on immediate post-operative radiographs of 75 aCAS and 75 CON knees. Outlier measurements were defined as DFA outside of 5° ±3° valgus; PTA >±3° from neutral axis; and PSA outside 0-7° for Cruciate Retaining (CR) and 0-5° for Posterior Stabilized (PS) implants. Data was analyzed using chi-squared, ANOVA and Student's t-tests.</p><p><strong>Results: </strong>There was no significant difference found between these two groups in the total number of outliers (8% aCAS versus 9.8% CON, p=0.508). Additionally, there was also no significant difference found for any of the radiographic measurements independently; DFA (8% versus 8%, p=1.00), PTA (4% versus 9%, p=0.184), and PSA (12% versus 12%, p=1.00), when comparing aCAS and CON TKA's.</p><p><strong>Conclusions: </strong>Primary TKAs performed at a single training institution demonstrated no significant difference between aCAS and CON methods in the total number of outliers or in the number of outliers for each postoperative radiographic measurement. This study would suggest that there is no advantage in limiting outliers when utilizing aCAS for TKAs at training institutions in cases that trainees are involved in.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Lateral Extra-articular Tenodesis for ongoing instability following Anterior Cruciate Ligament (ACL) reconstruction with an intact graft is effective and has low surgical morbidity.","authors":"Peter Samuel Edward Davies, Cameron Muirhead, Alistair I W Mayne, Jay R Ebert, Peter K Edwards, Ashley Simpson, Andrew Williams, Peter Alberto D'Alessandro","doi":"10.1055/a-2481-8771","DOIUrl":"https://doi.org/10.1055/a-2481-8771","url":null,"abstract":"<p><p>Purpose The management of persisting instability following anterior cruciate ligament reconstruction (ACLR) includes isolated lateral extra articular tenodesis (LEAT). The present study investigates the outcomes following isolated LEAT to address ongoing instability following ACLR without LEAT. Materials and Methods Patients with ongoing symptomatic instability following ACLR with a radiologically intact and well positioned graft who underwent an isolated LEAT between January 2017 and March 2022 were retrospectively recruited. Patients completed patient reported outcome measures (PROMs) at baseline and mean 26 months post operatively. Results Twelve knees in 11 patients underwent an isolated LEAT. All KOOS domains improved significantly between pre and post operative measurements (Pain 60.9 to 91.7, p=0.002; Symptoms 62.5 to 93.8 p=0.003; ADLs 64.3 to 95.2, p=0.002; Sport 61.9 to 82.5, p=0.012; QOL 17.2 to 80.2, p=0.002). One patient required revision ACL surgery 19 months following their subsequent LEAT procedure. Conclusions An isolated LEAT demonstrated clinically significant improvements in patient function and activity with acceptable surgical morbidity and should be considered as an option for appropriate cases with instability despite an intact ACL graft.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Review of Revision and Re-revision Patella Osteosynthesis Performed for Failure of Fixation of Initial Comminuted Fracture Patterns: Very High Complication Rates.","authors":"Wayne Hoskins, Charles Gusho, Rown Parola, Steven DeFroda, Douglas Haase","doi":"10.1055/a-2451-6924","DOIUrl":"10.1055/a-2451-6924","url":null,"abstract":"<p><p>Literature on revision osteosynthesis for failed patella fracture fixation is extremely limited. This study reviews the treatment options and outcomes for revision and re-revision osteosynthesis at a Level 1 trauma center. All patella revision osteosynthesis cases between January 2021 and March 2024 were identified using Current Procedural Terminology codes at a single tertiary care academic center. Medical records, operative reports, and radiographs were reviewed to collect details regarding patient demographics, initial injury and fracture management, indications for revision surgery, revision construct, postoperative weight bearing and range-of-motion restrictions, and outcomes. The primary outcome was major failure defined as loss of fixation or further surgery for nonunion or infection. Ten patients underwent revision osteosynthesis for failed fixation. All fractures were initially comminuted fracture patterns (AO/OTA 34-C3), with nine (90%) initially treated with a 2.7-mm patella-specific variable angle locking plate (Synthes, Paoli, PA). Half (<i>n</i> = 5) of the patients were revised with the same patella-specific plate and half with an all suture transosseous fibertape tension band (Arthrex, Naples, FL). Additional fixation in the form of bony augmentation was performed in 20% (<i>n</i> = 2) of cases and soft tissue augmentation in 70% (<i>n</i> = 7). There was a 70% (<i>n</i> = 7) major failure rate, mostly due to loss of inferior pole fixation. There were four re-revision procedures performed with surgical fixation. Two of these subsequently developed infection, one united and the other had no radiographic signs of union and was lost to follow-up, but was without complication. Regardless of the chosen fixation construct, revision osteosynthesis for failed fixation of initial comminuted fracture patterns has an extremely high rate of failure. Complications increase with further revision surgery. Level of evidence: therapeutic level 3.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leaving the Patella Unresurfaced Does Not Increase the Risk of Short-Term Revision Following Total Knee Arthroplasty: An Analysis from the American Joint Replacement Registry (AJRR).","authors":"Dencel García Vélez, Anirudh Buddhiraju, Ryland Kagan, Isabella Zaniletti, Ayushmita De, Harpal S Khanuja, Chris Pelt, Vishal Hegde","doi":"10.1055/a-2468-6289","DOIUrl":"https://doi.org/10.1055/a-2468-6289","url":null,"abstract":"<p><p>Introduction The benefit of patellar resurfacing in total knee arthroplasty (TKA) remains uncertain, with conflicting evidence regarding associated revision rates and clinical outcomes. Although initial studies have reported higher revision rates associated with unresurfaced patellae, recent evidence questions the necessity of routine patellar resurfacing. This study aimed to evaluate the risk of revision following TKA performed with and without patellar resurfacing using data from the American Joint Replacement Registry (AJRR). Material and methods The AJRR was queried for all patients aged 65 and older undergoing elective TKA between January 2012 and March 2020 with a minimum 2-year follow-up. Cases were linked using supplemental Centers for Medicare and Medicaid data. Cases with hybrid fixation, highly constrained implants, and revision components were excluded. Patients were categorized into two groups: those with a resurfaced patella and those without. Cumulative incidence function (CIF) curves and cause-specific Cox models were utilized to assess all-cause revision risk, adjusting for sex, age, femoral design (cruciate retaining vs posterior stabilized), fixation type (cemented vs cementless), and Charlson Comorbidity Index (CCI). Results Of the 390,304 TKAs with minimum two-year follow-up in our cohort, 22,829 had no patellar resurfacing performed. Adjusted Hazard Ratios (HR) revealed no significant difference in all-cause revision (HR=0.96, 95% CI 0.81-1.13, p=0.656), revision for mechanical loosening (HR=1.61 [0.88, 2.93], p=0.122), or revision for infection (HR=1.02 [0.79, 1.33], p=0.860) associated with patellar resurfacing status. Conclusion Our study found that patients with an unresurfaced patella do not face an increased short-term revision risk following TKA. These findings challenge the necessity of routine patellar resurfacing and underscore the importance of considering other factors, such as femoral design, patient comorbidities, and implant-related variables in revision risk stratification.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}