Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
Department of Neurosurgery, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
J Arthroplasty. 2018 Jun;33(6):1962-1971.e3. doi: 10.1016/j.arth.2017.12.024. Epub 2018 Jan 2.
A systematic review and meta-analysis was performed to investigate the risks associated with anterior knee pain (AKP) following primary total knee arthroplasty (TKA).
A computerized search was performed of the following databases: MEDLINE, Embase, and Cochrane Central (published prior to July 2017). A total of 37 studies, which included 1641 cases of AKP and 168,090 TKAs, were included in the meta-analysis.
A subgroup analysis revealed that compared with those without the following medical conditions, patients who had an infrapatellar fat pad excision and more than 12 months of follow-up (odds ratio [OR] 12.58, 95% confidence interval [CI] 3.245-48.781) were more likely to have AKP after TKA. Circumpatellar electrocautery (>12 months: OR 0.50, 95% CI 0.326-0.760; ≤12 months: OR 0.59, 95% CI 0.408-0.867) and patellar resurfacing (OR 0.25, 95% CI 0.131-0.485) may decrease the risk of AKP. Other factors, including the prosthesis bearing type (mobile bearing or fixed bearing) and the approach (midvastus compared with the medial parapatellar approach), were not significant risk factors for AKP.
The use of strategies such as patellar denervation and patellar resurfacing in primary TKA is recommended because they are safe and result in good clinical outcomes in preventing AKP. Caution should be taken when using an infrapatellar fat pad excision, because there is an increased risk of AKP at long-term follow-up (>12 months). Future studies should investigate these different strategies to confirm the underlying mechanisms and help prevent the occurrence of AKP after TKA. The timing of AKP onset remains unclear and requires further research.
系统评价和荟萃分析旨在调查初次全膝关节置换（TKA）后发生前膝痛（AKP）的风险。
计算机检索 MEDLINE、Embase 和 Cochrane Central（截至 2017 年 7 月前发表的文献）。纳入的荟萃分析共包含 37 项研究，共计 1641 例 AKP 和 168090 例 TKA。
亚组分析显示，与不具有以下合并症的患者相比，切除髌下脂肪垫且随访时间超过 12 个月（比值比[OR] 12.58，95%置信区间[CI] 3.245-48.781）、采用环周髌周电灼（>12 个月：OR 0.50，95% CI 0.326-0.760；≤12 个月：OR 0.59，95% CI 0.408-0.867）和髌骨表面置换（OR 0.25，95% CI 0.131-0.485）的患者术后发生 AKP 的可能性更小。其他因素，包括假体轴承类型（活动轴承或固定轴承）和入路（改良髌旁内侧入路与髌旁正中入路），并不是 AKP 的显著危险因素。
在初次 TKA 中，建议使用诸如髌骨去神经和髌骨表面置换等策略，因为它们安全，并且在预防 AKP 方面具有良好的临床效果。在使用髌下脂肪垫切除时应谨慎，因为在长期随访（>12 个月）中，AKP 的风险会增加。未来的研究应该进一步调查这些不同的策略，以确定潜在的机制，并帮助预防 TKA 后 AKP 的发生。AKP 发病的时间尚不清楚，需要进一步研究。
