Department of Orthopaedics, the Second Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, Zhejiang 310009, China.
Chin Med J (Engl). 2010 Nov;123(21):3020-3.
Isolated patellofemoral osteoarthritis is not uncommon. Surgical treatment of isolated patellofemoral arthritis remains controversial and poses a challenging treatment dilemma. The present study aimed to evaluate the short-term results of patellofemoral arthroplasty for patients with isolated patellofemoral osteoarthritis.
We analyzed 11 patellofemoral arthroplasties performed from March 2006 to September 2009 in 11 patients with isolated patellofemoral arthritis. The patients comprised 2 males and 9 females with an average age of 53.7 years (range, 46 - 74 years). Standard weightbearing radiographs were taken in the anteroposterior, lateral, and 45° axial views. The knee pain and functional status were evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scales and American Knee Society (AKS) scores. For comparison, 23 total knee arthroplasties in 23 patients with primary tibiofemoral osteoarthritis were matched according to age, gender, bilaterality and body mass index. The duration of follow-up was 23.7 months (range, 12 - 47 months).
The majority of the 11 patients experienced improvement in their patellofemoral symptoms after patellofemoral arthroplasty. The WOMAC scores improved considerably by 7.4 points with respect to pain and by 5.2 points with respect to function. The AKS scores also improved considerably by 23.9 points with respect to pain and 44.3 points with respect to function. Although the clinical outcomes after patellofemoral arthroplasty were not better than those after total knee arthroplasty, patellofemoral arthroplasty exhibited advantages in the shorter operation time, lower blood loss and increased postoperative range of motion. At the latest follow-up, there was no clinical or radiographic evidence of patellofemoral maltracking, loosening or wear.
On the basis of our experience in this relatively small series of patients with a short-term follow-up, patellofemoral arthroplasty is an effective treatment alternative to total knee arthroplasty in isolated patellofemoral arthritis. MRI and arthroscopy may contribute to define those patients with isolated patellofemoral degeneration.
孤立性髌股关节炎并不少见。孤立性髌股关节炎的手术治疗仍存在争议，构成了具有挑战性的治疗难题。本研究旨在评估髌股关节炎患者行髌股置换术的短期疗效。
我们分析了 2006 年 3 月至 2009 年 9 月期间 11 例孤立性髌股关节炎患者的 11 例髌股置换术。患者 2 例为男性，9 例为女性，平均年龄 53.7 岁（范围 46-74 岁）。标准负重正位、侧位和 45°轴位 X 线片。采用 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）评分和美国膝关节协会（AKS）评分评估膝关节疼痛和功能状况。为了比较，我们根据年龄、性别、双侧和体重指数，在 23 例原发性胫股关节炎患者中匹配了 23 例全膝关节置换术。随访时间为 23.7 个月（范围 12-47 个月）。
11 例患者髌股症状在髌股置换术后多数得到改善。WOMAC 评分在疼痛方面改善了 7.4 分，在功能方面改善了 5.2 分。AKS 评分在疼痛方面改善了 23.9 分，在功能方面改善了 44.3 分。虽然髌股置换术后的临床疗效并不优于全膝关节置换术，但髌股置换术在手术时间更短、出血量更少、术后活动范围更大方面具有优势。末次随访时，无髌股对线不良、松动或磨损的临床或影像学证据。
根据我们对这组短期随访的相对较小系列患者的经验，髌股置换术是孤立性髌股关节炎的一种有效治疗选择，可替代全膝关节置换术。MRI 和关节镜检查可能有助于确定那些孤立性髌股退变的患者。
