Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel.
Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2018 Jun;26(6):1805-1810. doi: 10.1007/s00167-017-4803-4. Epub 2017 Nov 29.
The primary purpose of the study was to investigate if and how patellar bone tracer uptake (BTU) distribution in SPECT/CT is influenced by patellar resurfacing and the position of femoral and tibial TKA component position.
A total of 104 knees of 103 consecutive patients who underwent primary TKA were prospectively investigated. Primary patellar resurfacing was done in 40 knees while 64 had a TKA without patellar resurfacing. All patients underwent clinical assessment using the knee society score (KSS) and standardized radiographs and Tc-99m-HDP-SPECT/CT before and 12 and 24 months after TKA. Measurements of BTU including intensity and anatomical distribution pattern in eight different patellar regions were performed. Tibial and femoral TKA component position was assessed from 3D reconstructed CT data. Patellar height, thickness and tilt were measured and the distance between the tibial tuberosity and the trochlear groove (TT-TG) was measured. Univariate analysis was performed to identify differences between the two groups (p < 0.05).
Significantly higher BTU was found in the anterior, non-articular, areas of the patella in patients who underwent patellar resurfacing (p < 0.05). The BTU pattern was similar between the groups, as the maximal uptake in both groups was seen in the superior posterior parts and the minimal uptake was seen in the inferior anterior parts. The mean postoperative KSS was significantly higher in the unresurfaced group after 12 months (p < 0.05), but with no significant difference after 24 months.
Based on the findings of the present study, patellar resurfacing is related to significantly higher BTU in the anterior parts of the patella and lower clinical outcomes. In light of these results, routine patellar resurfacing as part of a primary TKA might be reevaluated. SPECT/CT enables a precise localization of the BTU and might be considered as the ideal imaging modality for evaluation and investigate of patellofemoral disorders after TKA.
本研究的主要目的是探讨髌股骨示踪剂摄取（BTU）在 SPECT/CT 中的分布是否以及如何受到髌股表面置换和股骨及胫骨 TKA 组件位置的影响。
前瞻性调查了 103 例连续接受初次 TKA 的 104 膝。40 例进行了原发性髌股表面置换，64 例未进行髌股表面置换的 TKA。所有患者均在 TKA 前、后 12 个月和 24 个月进行临床评估，采用膝关节学会评分（KSS）和标准 X 线片及 Tc-99m-HDP-SPECT/CT。测量了 8 个不同髌区的 BTU 包括强度和解剖分布模式。从 3D 重建 CT 数据评估胫骨和股骨 TKA 组件位置。测量髌股高度、厚度和倾斜度，并测量胫骨结节与滑车沟（TT-TG）之间的距离。采用单变量分析比较两组之间的差异（p<0.05）。
接受髌股表面置换的患者髌前、非关节区的 BTU 明显升高（p<0.05）。两组之间的 BTU 模式相似，两组的最大摄取均位于后上部分，最小摄取均位于前下部分。未置换组术后 12 个月 KSS 明显升高（p<0.05），但 24 个月后无差异。
根据本研究的结果，髌股表面置换与髌前区 BTU 明显升高和较低的临床结果有关。鉴于这些结果，作为初次 TKA 的一部分，常规髌股表面置换可能需要重新评估。SPECT/CT 能够精确定位 BTU，可作为 TKA 后髌股系统疾病评估和研究的理想成像方式。
