Asadollahi Saeed, Sorial Rami, Coffey Simon, Gupta Manish, Eslick Guy D
Department of Orthopaedics, Nepean Hospital, Sydney, NSW, Australia.
Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, NSW, Australia.
Knee. 2017 Mar;24(2):191-196. doi: 10.1016/j.knee.2017.01.004. Epub 2017 Feb 9.
Post-patellectomy patients represent a specific subset of patients who can develop painful and disabling knee osteoarthritis that requires Total Knee Arthroplasty (TKA). The aim of this study was to conduct a meta-analysis comparing the outcome of TKA in patients with previous patellectomy to those with an intact patella.
A systematic search of electronic databases (PubMed, Medline, Embase, and Cochrane Library) was performed. Data on study setting, type of implant, outcome and associated complications were extracted. Quality assessment was performed using the Newcastle-Ottawa Scale. Random effects meta-analyses were used to combine the results of included studies.
Seven case-control studies were found that met the search criteria. Compared to patients with an intact patella, patients with a previous patellectomy were less likely to have an 'excellent' or 'good' outcome (OR: 0.3, 95% CI: 0.14 to 0.65). The weighted mean post-operative knee flexion arc was 6.58° less in patients with a previous patellectomy (95% CI: -12.79, -0.37). The risk of complication occurring in a patella-deficient knee was higher, with a pooled OR of 1.97 (95% CI=1.10 to 3.51).
The current evidence that compares the outcome of knee arthroplasty in patients with a previous patellectomy to patients with an intact patella is mostly based on TKAs performed in the 1980s and 1990s. Total knee replacement in patients with an intact patella results in superior outcomes compared to those with a previous patellectomy. In patients with a previous patellectomy, the arc of flexion is slightly less and the complication rate is significantly higher.
髌骨切除术后患者是一类特殊的患者群体，他们可能会患上疼痛且致残的膝关节骨关节炎，进而需要进行全膝关节置换术（TKA）。本研究的目的是进行一项荟萃分析，比较既往有髌骨切除术的患者与髌骨完整的患者进行TKA的结果。
对电子数据库（PubMed、Medline、Embase和Cochrane图书馆）进行系统检索。提取有关研究背景、植入物类型、结果及相关并发症的数据。使用纽卡斯尔-渥太华量表进行质量评估。采用随机效应荟萃分析来合并纳入研究的结果。
发现七项符合检索标准的病例对照研究。与髌骨完整的患者相比，既往有髌骨切除术的患者获得“优秀”或“良好”结果的可能性较小（比值比：0.3，95%置信区间：0.14至0.65）。既往有髌骨切除术的患者术后膝关节屈曲弧度加权平均值少6.58°（95%置信区间：-12.79，-0.37）。髌骨缺失膝关节发生并发症的风险更高，合并比值比为1.97（95%置信区间=1.10至3.51）。
目前比较既往有髌骨切除术的患者与髌骨完整的患者膝关节置换术结果的证据大多基于20世纪80年代和90年代进行的TKA。与既往有髌骨切除术的患者相比，髌骨完整的患者进行全膝关节置换术的结果更好。既往有髌骨切除术的患者，其屈曲弧度略小，并发症发生率显著更高。
