Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, 210 East 64th Street, 4th Floor, New York, NY 10065, USA.
Clin Orthop Relat Res. 2012 Jan;470(1):205-10. doi: 10.1007/s11999-011-1995-7.
Restoring patellar height is important in revision TKA for normal knee function and kinematics. Alteration in patellar height after revision TKA is associated with inferior extensor mechanism function.
QUESTIONS/PURPOSES: We determined whether gap balancing with bone preservation and distal femoral augmentation would restore patellar height and patellar height changed in patients undergoing septic and aseptic revision TKA.
We retrospectively reviewed 76 patients who had revision TKA between 2006 and 2009; 12 had two-stage revisions for infected TKA, and 64 had revision for aseptic failure. We compared preoperative and postoperative radiographs and measured the patellar height using the Insall-Salvati ratio in both groups. We reviewed operative records to determine type of exposure and amount of distal femoral augmentation used to restore the joint line.
Overall mean preoperative and postoperative Insall-Salvati ratios were 1.02 and 1.04, respectively. In the septic group, mean preoperative and postoperative Insall-Salvati ratios were 1.07 and 0.99, respectively. In the aseptic group, mean preoperative and postoperative Insall-Salvati ratios were 1.01 and 1.05, respectively. Overall, nine patients had preoperative patella baja; seven of these had an improvement to normal height. There was little difference in preoperative and postoperative Insall-Salvati ratios in patients with patella alta. Distal augmentation was used in 10 of 12 patients in the septic group and 48 of 64 patients in the aseptic group.
Surgeons can maintain normal patellar height and improve patella baja by preserving bone stock and using distal femoral augments to restore the distal joint line during revision TKA.
在翻修 TKA 中恢复髌骨高度对于正常的膝关节功能和运动学非常重要。翻修 TKA 后髌骨高度的改变与伸肌机制功能低下有关。
问题/目的：我们确定了在进行感染性和无菌性翻修 TKA 的患者中，通过保留骨量和股骨远端增强来进行间隙平衡是否可以恢复髌骨高度以及髌骨高度的变化。
我们回顾性分析了 2006 年至 2009 年间接受翻修 TKA 的 76 例患者；12 例患者行两期翻修治疗感染性 TKA，64 例患者行无菌性失败翻修。我们比较了两组患者的术前和术后 X 线片，并测量了髌骨高度比（Insall-Salvati 比）。我们查阅了手术记录，以确定暴露的类型和用于恢复关节线的股骨远端增强的量。
总体而言，术前和术后的平均 Insall-Salvati 比分别为 1.02 和 1.04。在感染组中，术前和术后的平均 Insall-Salvati 比分别为 1.07 和 0.99。在无菌组中，术前和术后的平均 Insall-Salvati 比分别为 1.01 和 1.05。总体而言，9 例患者术前存在髌骨低位，其中 7 例恢复至正常高度。髌骨高位患者术前和术后 Insall-Salvati 比差异不大。在感染组的 12 例患者中有 10 例使用了股骨远端增强，在无菌组的 64 例患者中有 48 例使用了股骨远端增强。
在翻修 TKA 中，通过保留骨量和使用股骨远端增强来恢复远端关节线，外科医生可以维持正常的髌骨高度并改善髌骨低位。
