Martin J Ryan, Jennings Jason M, Watters Tyler S, Levy Daniel L, McNabb David Clinton, Dennis Douglas A
Colorado Joint Replacement, Porter Adventist Hospital, Denver, Colorado.
Raleigh Orthopaedic Clinic, Raleigh, North Carolina.
J Arthroplasty. 2017 Apr;32(4):1310-1313. doi: 10.1016/j.arth.2016.11.025. Epub 2016 Nov 22.
Patellar crepitus is a complication most commonly seen in patients implanted with a posterior-stabilized total knee arthroplasty (TKA). Recently, design changes in the patellofemoral geometry and the intercondylar box ratio have been optimized in newer TKA designs. A comparative study was performed to analyze the incidence of patellar crepitus between a historical vs modern TKA design.
A retrospective review of all patients at our institution that underwent a primary TKA with either a PFC Sigma or Attune posterior-stabilized TKA (DePuy, Inc, Warsaw, IN), with a minimum of 1-year follow-up duration was performed. A total of 1165 participants implanted with the PFC Sigma and 728 with the Attune design were analyzed. Patellar crepitus incidence, functional scores, and range of motion were recorded at each follow-up appointment. Statistical analyses were performed between the 2 groups to determine if there were differences in clinical outcomes.
The incidence of crepitus in participants implanted with the Attune was 0.55% vs 6.26% in the PFC Sigma cohort (P < .001) at 1 year vs. 0.83% vs 9.4%, respectively at 2 years post operatively (P < .001). There were small differences in extension, flexion, and Knee Society Scores between the 2 groups that were not clinically meaningful.
The Attune posterior-stabilized TKA demonstrated substantially less patellofemoral crepitus incidence than the historical control. We hypothesize that these findings are related to femoral component changes including a thinner and narrower anterior flange and a reduced femoral intercondylar box ratio.
髌股关节摩擦音是后稳定型全膝关节置换术（TKA）患者中最常见的并发症。最近，在新型TKA设计中，髌股关节几何形状和髁间盒比例的设计已得到优化。本研究进行了一项对比研究，以分析传统TKA设计与现代TKA设计中髌股关节摩擦音的发生率。
对我院所有接受初次TKA手术且使用PFC Sigma或Attune后稳定型TKA（DePuy公司，印第安纳州华沙）的患者进行回顾性研究，随访时间至少为1年。共分析了1165例植入PFC Sigma的参与者和728例植入Attune设计的参与者。每次随访时记录髌股关节摩擦音发生率、功能评分和活动范围。对两组进行统计学分析，以确定临床结果是否存在差异。
在1年时，植入Attune的参与者中摩擦音发生率为0.55%，而PFC Sigma队列中为6.26%（P <.001）；术后2年时，分别为0.83%和9.4%（P <.001）。两组在伸展、屈曲和膝关节协会评分方面存在微小差异，但在临床上无意义。
Attune后稳定型TKA的髌股关节摩擦音发生率明显低于传统对照组。我们推测，这些结果与股骨部件的变化有关，包括更薄更窄的前凸缘和更小的股骨髁间盒比例。
