Arthritis Surgery Research Foundation, Miami, Florida.
Florida International University, Miami, Florida.
J Arthroplasty. 2017 Dec;32(12):3621-3625. doi: 10.1016/j.arth.2017.06.046. Epub 2017 Jul 5.
Maintenance of the native patellar thickness has been deemed important for proper clinical outcomes after total knee arthroplasty (TKA). Our objective was to study the effects of the change in patellar thickness on patient-perceived outcomes (PPOs) after TKA. We hypothesized that reestablishing native patellar thickness after TKA results in better PPOs.
819 consecutive patients undergoing primary TKA were studied. Patients were classified according to their postoperative patellar thickness into: (1) less than native patella thickness; (2) equal to native patella thickness; and (3) greater than native patella thickness. Difference in postoperative range of motion (ROM), PPOs and clinical scores, and delta-Δ-change were assessed. MANCOVA was used to assess for differences.
No significant differences found based on postoperative patellar thickness (mean follow-up: 4.9 ± 2.1 years) for each ROM assessments. Those who reported more stiffness (Western Ontario and McMaster Universities Arthritis Index stiffness; P = .011) and lower knee active flexion (P = .046) preoperatively had "greater than native patella thickness" after surgery. Postoperatively, the "equal to native patella thickness" group reported significantly better quality of life (quality of well-being scale 7 total; P = .008) as well as better physical score (Short Form-36 role physical score; P = .03). The amount of improvement (delta-Δ-change), when restoring patellar thickness equal to the native demonstrated greatest improvements in quality of life (quality of well-being scale 7 total; P = .016) physical measures (Short Form-36 role physical [P = .025], and Western Ontario and McMaster Universities Arthritis Index stiffness scores [P = .006]).
When compared with the native patellar thickness, a final postoperative difference (delta thickness) that ranges from -1.06 to 2.58 mm provides satisfactory results and does not seem to affect ROM after surgery.
维持髌骨的原有厚度被认为对全膝关节置换术（TKA）后的临床结果很重要。我们的目的是研究 TKA 后髌骨厚度变化对患者感知结局（PPO）的影响。我们假设在 TKA 后重建髌骨的原有厚度会带来更好的 PPO。
对 819 例连续接受初次 TKA 的患者进行了研究。根据术后髌骨厚度将患者分为：（1）小于髌骨原有厚度；（2）等于髌骨原有厚度；（3）大于髌骨原有厚度。评估术后活动范围（ROM）、PPO 和临床评分的差异和Δ-Δ-变化。使用 MANCOVA 评估差异。
根据术后髌骨厚度（平均随访时间：4.9±2.1 年），在每个 ROM 评估中均未发现显著差异。那些术前报告有更多僵硬（西安大略和麦克马斯特大学关节炎指数僵硬；P=0.011）和较低的膝关节主动屈曲（P=0.046）的患者，术后出现“大于髌骨原有厚度”。术后，“等于髌骨原有厚度”组报告的生活质量明显更好（幸福感量表 7 总分；P=0.008），身体评分更好（36 项简短健康调查问卷身体角色评分；P=0.03）。当恢复髌骨厚度与正常髌骨厚度相等时，改善量（Δ-Δ-变化）显示出对生活质量（幸福感量表 7 总分；P=0.016）和身体测量（36 项简短健康调查问卷身体角色评分[P=0.025]和西安大略和麦克马斯特大学关节炎指数僵硬评分[P=0.006]）的最大改善。
与髌骨原有厚度相比，术后最终差异（厚度差异）在-1.06 至 2.58mm 范围内提供了满意的结果，似乎不会影响术后 ROM。
