全膝关节置换术中的髌骨置换:一项前瞻性随机研究

T. Waters, G. Bentley
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引用次数: 283

摘要

背景:全膝关节置换术后膝关节前部疼痛是一种常见的主诉,通常归因于髌股关节。本研究的目的是比较髌骨表面置换和非髌骨表面置换的结果,特别是关于膝关节前部疼痛,并澄清全膝关节置换术时髌骨表面置换的适应症。方法:我们进行了一项前瞻性的随机研究,514例连续的初级按压式髁突全膝关节置换术。患者随机分为髌骨表面置换组和髌骨保留组。作为单独试验的一部分,他们也被随机分配到十字架替代假体或十字架保留假体。平均随访时间为5.3年(2 - 8.5年),患者通过膝关节协会评分、临床前膝关节疼痛评分和英国骨科协会患者满意度评分进行评估。评估是在审查员不知道髌骨是否已经重新表面的情况下进行的。随访时,共有474个膝关节。35例双侧膝关节置换术患者仅在一侧进行了膝关节置换术。结果:膝关节前侧疼痛的总体发生率在非置换组为25.1%(231个膝关节中58个),而置换组为5.3%(243个膝关节中13个)(p < 0.0001)。有一例部件松动。11例接受二次表面置换的患者中有10例膝关节前侧疼痛完全缓解。非表面修复组术后膝关节整体评分较低,骨关节炎组差异有统计学意义(p < 0.01)。在术后功能评分方面,表面修复组和非表面修复组没有显著差异。双侧膝关节置换术的患者更倾向于选择表面修复的一侧。结论:由于目前的研究显示关节置换术后不进行髌骨表面置换的膝关节前侧疼痛率明显更高,我们建议在技术允许的情况下在全膝关节置换术时进行髌骨表面置换。证据水平:治疗性研究,I-1a级(随机对照试验[显著差异])。有关证据水平的完整描述,请参见作者说明。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Patellar Resurfacing in Total Knee Arthroplasty: A Prospective, Randomized Study
Background: Anterior knee pain following total knee arthroplasty is a common complaint and typically is attributed to the patellofemoral joint. The purpose of the present study was to compare the outcome of resurfacing and nonresurfacing of the patella, particularly with regard to anterior knee pain, and to clarify the indications for patellar resurfacing at the time of total knee arthroplasty.Methods: We performed a prospective, randomized study of 514 consecutive primary press-fit condylar total knee replacements. The patients were randomized to either resurfacing or retention of the patella. They were also randomized to either a cruciate-substituting or a cruciate-retaining prosthesis as part of a separate trial. The mean duration of follow-up was 5.3 years (range, two to 8.5 years), and the patients were assessed with use of the Knee Society rating, a clinical anterior knee pain score, and the British Orthopaedic Association patient-satisfaction score. The assessment was performed without the examiner knowing whether the patella had been resurfaced. At the time of follow-up, there were 474 knees. Thirty-five patients who had a bilateral knee replacement underwent resurfacing on one side only.Results: The overall prevalence of anterior knee pain was 25.1% (fifty-eight of 231 knees) in the nonresurfacing group, compared with 5.3% (thirteen of 243 knees) in the resurfacing group (p < 0.0001). There was one case of component loosening. Ten of eleven patients who underwent secondary resurfacing had complete relief of anterior knee pain. The overall postoperative knee scores were lower in the nonresurfacing group, and the difference was significant among patients with osteoarthritis (p < 0.01). There was no significant difference between the resurfacing and nonresurfacing groups with regard to the postoperative function score. Patients who had a bilateral knee replacement were more likely to prefer the resurfaced side.Conclusions: As the present study showed a significantly higher rate of anterior knee pain following arthroplasty without patellar resurfacing, we recommend patellar resurfacing at the time of total knee replacement when technically possible.Level of Evidence: Therapeutic study, Level I-1a (Randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.
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