Lachiewicz Paul F, Soileau Elizabeth S
Department of Orthopaedics, University of North Carolina, Chapel Hill, NC 27599-7055, USA.
Clin Orthop Relat Res. 2006 Nov;452:155-8. doi: 10.1097/01.blo.0000238803.97713.7d.
Maltracking of the patella component in total knee arthroplasty usually leads to complications such as subluxation, dislocation, fracture, excessive wear, or implant failure. After using a new posterior-stabilized total knee arthroplasty and a specific protocol for the patellofemoral articulation we determined the incidence of lateral retinacular release and patella complications. We retrospectively reviewed 255 consecutive primary posterior-stabilized total knee arthroplasties with an anatomic femoral component and a three-peg offset-dome patella. Component alignment was achieved using Whiteside's lines for the femoral component, the medial border of the tubercle for the tibial component, and previously reported techniques for the patella. Lateral release was performed in 15 knees (6.2%), most of which had excessive preoperative valgus (mean, 15 degrees). There were no reoperations for the patellofemoral joint at a mean followup of 3.7 years (range, 2-7 years). Two patients had asymptomatic osteonecrosis of the patella with complete radiolucent lines, and one patella fracture was treated with immobilization. We believe patella maltracking a largely avoidable problem in total knee arthroplasty. We found a low incidence of lateral retinacular release and patella complications using these components and this protocol for the patellofemoral articulation.
全膝关节置换术中髌骨组件轨迹不良通常会导致诸如半脱位、脱位、骨折、过度磨损或植入物失效等并发症。在使用一种新型后稳定型全膝关节置换术及特定的髌股关节处理方案后，我们确定了外侧支持带松解及髌骨并发症的发生率。我们回顾性分析了255例连续的初次后稳定型全膝关节置换术，这些手术均采用解剖型股骨组件和三钉偏置穹顶髌骨。使用Whiteside线确定股骨组件的位置，胫骨结节内侧缘确定胫骨组件的位置，以及先前报道的技术确定髌骨的位置。15例膝关节（6.2%）进行了外侧松解，其中大多数术前存在过度外翻（平均15度）。平均随访3.年（范围2至7年），髌股关节无再次手术病例。2例患者出现无症状的髌骨骨坏死，X线显示完全透亮线，1例髌骨骨折采用固定治疗。我们认为在全膝关节置换术中髌骨轨迹不良在很大程度上是一个可避免的问题。使用这些组件及该髌股关节处理方案，我们发现外侧支持带松解及髌骨并发症的发生率较低。
