Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy.
Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy; Department of Orthopaedic and Trauma Surgery, University of Melbourne, Melbourne Medical School, Melbourne, Victoria, Australia.
J Arthroplasty. 2018 Feb;33(2):620-632. doi: 10.1016/j.arth.2017.08.041. Epub 2017 Sep 6.
Patellar resurfacing in total knee arthroplasty remains controversial. The aim of this study is to evaluate this technique through an analysis of comparative studies in the current literature.
We performed a comprehensive search of PubMed, MEDLINE, Cochrane, CINAHL, and EMBASE databases using various combinations of the keywords "Knee," "Replacement," "Prosthesis," "Patella," "Resurfacing," and "Arthroplasty." All articles relevant to the subject were retrieved, and their bibliographies were hand searched for further references relevant to primary patellar resurfacing in total knee arthroplasty. Only articles published in peer-reviewed journals were included in this systematic review.
The percentage for a reoperation was 1% for the patellar resurfacing group (17/1636) and 6.9% for the non-resurfacing group (118/1699) (odds ratio [OR] 0.18, 95% confidence interval [CI] 0.11-0.29, P < .00001). The patellar resurfacing group showed a significantly higher postop Knee Society Score (KSS) pain (OR 1.52, 95% CI 0.68-2.35, P = .004) and postop Hospital for Special Surgery score (OR 4.35, 95% CI 3.21-5.49, P < .00001), over the non-resurfacing group.
Based on the outcome scores of KSS (pain), KSS (function), and Hospital for Special Surgery postop, patellar resurfacing TKAs have performed better than non-resurfaced TKAs. The lower secondary operation and revision rates for patellar resurfaced TKAs also demonstrate that this technique is the more effective option. However, the full impact of patellar resurfacing still needs to be critically evaluated by larger randomized controlled trials with long-term follow-up.
全膝关节置换术中髌骨再处理仍存在争议。本研究旨在通过分析当前文献中的对照研究来评估该技术。
我们使用“膝关节”、“置换”、“假体”、“髌骨”、“再处理”和“关节成形术”等关键词，在 PubMed、MEDLINE、Cochrane、CINAHL 和 EMBASE 数据库中进行了全面检索，并采用了各种组合方式。检索到所有与主题相关的文章，并对其参考文献进行手工搜索，以获取与全膝关节置换术中髌骨初次再处理相关的进一步参考文献。本系统评价仅纳入经同行评议的期刊发表的文章。
髌骨再处理组的再次手术率为 1%（17/1636），而非再处理组为 6.9%（118/1699）（比值比 [OR] 0.18，95%置信区间 [CI] 0.11-0.29，P <.00001）。髌骨再处理组术后膝关节学会评分（KSS）疼痛（OR 1.52，95%CI 0.68-2.35，P =.004）和术后特殊外科医院评分（OR 4.35，95%CI 3.21-5.49，P <.00001）均显著高于非再处理组。
基于 KSS（疼痛）、KSS（功能）和特殊外科医院术后评分的结果，髌骨再处理 TKA 比非再处理 TKA 表现更好。髌骨再处理 TKA 的二次手术和翻修率较低也表明该技术是更有效的选择。然而，髌骨再处理的全面影响仍需要通过具有长期随访的更大规模随机对照试验来进行批判性评估。
