van Hemert Wouter L W, Senden Rachel, Grimm Bernd, Kester Arnold D M, van der Linde Matthijs J A, Heyligers Ide C
Department of Orthopaedic Surgery and Traumatology, Atrium Medical Center, Postbus 4446, 6401 CX Heerlen, The Netherlands.
Arch Orthop Trauma Surg. 2009 Feb;129(2):259-65. doi: 10.1007/s00402-008-0640-8. Epub 2008 May 17.
Whether to resurface the patella or not in total knee arthroplasty still remains undecided. Classical scores and questionnaires might not be responsive or demanding enough. This study used two accelerometer based systems to study the hypothesis whether performance based tests are able to detect a difference in patients with or without a resurfaced patella.
In this retrospective study 53 patients were included and divided into a resurfaced group (n = 31) and a non-resurfaced group (n = 22). Both groups were matched on age and longevity of follow up. Patients were clinically assessed using the Knee Society Score (KSS) at various time points. At final follow up patients were also assessed once using the Dynaport Knee Test and the Minimod Gait Test.
The Dynaport Knee Test showed a significant functional advantage for patients with a resurfaced patella [44 vs. 39.7 (P = 0.042)], whereas KSS and The Minimod were not significant (P values ranging from 0.07 to 0.75). Similar to other reports in literature, using the KSS, it was not possible to identify significant difference between patella resurfacing or retaining in total knee arthroplasty, however using a performance based test it was possible to determine significant difference. The found advantage of patella resurfacing may be less due to pain relief but due to a functional benefit during demanding motion tasks. This finding indicates that current measurement tools may not be accurate or specific enough to detect this difference. Therefore, we recommend complementing the classic evaluation tools with an objective functional test, when conducting a randomized trial to answer the indecision whether to resurface the patella or not.
在全膝关节置换术中是否对髌骨进行表面置换仍未确定。传统的评分和问卷可能不够灵敏或要求不高。本研究使用了两种基于加速度计的系统来研究基于性能的测试是否能够检测出髌骨表面置换患者与未置换患者之间的差异这一假设。
在这项回顾性研究中，纳入了53名患者，并将其分为表面置换组（n = 31）和未置换组（n = 22）。两组在年龄和随访时间上相匹配。在不同时间点使用膝关节协会评分（KSS）对患者进行临床评估。在最终随访时，还使用动态端口膝关节测试和微型步态测试对患者进行了一次评估。
动态端口膝关节测试显示，髌骨表面置换患者具有显著的功能优势[44对39.7（P = 0.042）]，而KSS和微型步态测试结果不显著（P值范围为0.07至0.75）。与文献中的其他报告类似，使用KSS无法确定全膝关节置换术中髌骨表面置换或保留之间的显著差异，然而使用基于性能的测试则可以确定显著差异。发现的髌骨表面置换优势可能较少归因于疼痛缓解，而是由于在高要求运动任务中的功能益处。这一发现表明，当前的测量工具可能不够准确或特异，无法检测到这种差异。因此，我们建议在进行随机试验以回答是否对髌骨进行表面置换这一不确定问题时，用客观功能测试补充经典评估工具。
