Department of Orthopaedic and Trauma Surgery, Unit of Knee, Hospital Clínic of Barcelona, University of Barcelona, C/Villarroel 170, 08036 Barcelona, Spain.
Knee Surg Sports Traumatol Arthrosc. 2011 Sep;19(9):1467-72. doi: 10.1007/s00167-011-1402-7. Epub 2011 Feb 3.
This paper reports a prospective review of patients who, between 2004 and 2007, underwent secondary patellar resurfacing (SPR) due to anterior knee pain after a primary total knee arthroplasty (TKA). The aim was to evaluate the clinical outcomes obtained with the SPR and to compare them with radiological findings.
A total of twenty-seven consecutive patients met the inclusion criteria. There were twenty-three (85%) women and four (15%) men with a median age of 70 years. The patients were evaluated before and after the surgery with the same functional scores and radiological parameters. Bone scintigraphy was also used in the assessment, and a CT-scan was performed in order to evaluate the femoral component rotation. The median time between TKA and SPR was 18 months.
With a median follow-up of 23 months, seventeen patients (63%) reported a clear subjective improvement after SPR, and patellofemoral scores (primary outcome measure), KSS and WOMAC (secondary outcome measures) showed a statistically significant improvement following the procedure. There were no significant changes after SPR in the Insall-Salvati ratio, the lateral patellar displacement or the lateral patellar tilt. The mean time between TKA and SPR had no statistically significant effect on outcome. The bone scintigraphy revealed increased patellar uptake in seven cases, but this was not related to subsequent improvement after SPR. Rotational computed tomography showed a median internal rotation of the femoral component of 1º. The complications observed were a patellar component loosening and an acute post-infection.
No clinical or radiological parameter was found to be related to the final outcome after SPR. There was a discrepancy between functional scale scores and the patient's subjective satisfaction.
本研究报告了 2004 年至 2007 年间因初次全膝关节置换（TKA）后前膝疼痛而接受二次髌骨表面置换（SPR）的患者的前瞻性回顾。目的是评估 SPR 获得的临床结果，并将其与影像学发现进行比较。
共 27 例连续患者符合纳入标准。其中 23 例（85%）为女性，4 例（15%）为男性，中位年龄为 70 岁。患者在手术前后使用相同的功能评分和影像学参数进行评估。还使用骨闪烁扫描进行评估，并进行 CT 扫描以评估股骨组件的旋转。TKA 和 SPR 之间的中位时间为 18 个月。
中位随访 23 个月时，17 例（63%）患者报告 SPR 后主观明显改善，髌股评分（主要结局指标）、KSS 和 WOMAC（次要结局指标）在手术后均显示出统计学显著改善。SPR 后 Insall-Salvati 比、外侧髌骨位移或外侧髌骨倾斜均无显著变化。TKA 和 SPR 之间的中位时间对结果没有统计学显著影响。骨闪烁扫描显示 7 例髌骨摄取增加，但与 SPR 后随后的改善无关。旋转 CT 显示股骨组件的中位内旋转为 1°。观察到的并发症是髌骨组件松动和急性感染后。
未发现 SPR 后最终结果与任何临床或影像学参数相关。功能量表评分与患者的主观满意度之间存在差异。
