Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
J Arthroplasty. 2018 Jul;33(7):2136-2140. doi: 10.1016/j.arth.2018.02.075. Epub 2018 Feb 26.
The purpose of this study is to compare the clinical and radiographic outcomes of total knee arthroplasty (TKA) with patellar retention in accordance with the severity of patellofemoral arthritis.
We retrospectively reviewed patients who underwent TKA with patellar retention using the NexGen LPS or LPS-flex system between September 2010 and May 2015. The radiographic severity of patellofemoral arthritis was categorized according to the Iwano classification system, and subjects were divided into mild (stage 0-I) and moderate to severe (stage II-IV) groups. Clinical outcomes were evaluated using the Hospital for Special Surgery score, Knee Society Score, function score, Western Ontario and McMaster Universities Osteoarthritis Index, and Feller score. Radiographic outcomes were assessed using the congruence angle, patellar tilt angle, and lateral patellar displacement. The minimum follow-up for clinical and radiographic evaluation was 2 years. Clinical and radiographic outcomes were compared between the 2 groups preoperatively and at the time of the last follow-up.
Four hundred seventy-four knees were enrolled and assigned to mild (n = 208) or moderate to severe (n = 266) groups. The preoperative Feller score was significantly lower in the moderate to severe group (P = .030), whereas the postoperative clinical and radiographic results did not differ significantly between the 2 groups.
Clinical and radiographic outcomes did not differ in accordance with the severity of patellofemoral arthritis after a minimum 2 years of follow-up of patients treated with TKA with patellar retention. Good outcomes were obtained with patellar retention in TKA, even in patients with advanced patellofemoral osteoarthritis.
本研究旨在比较全膝关节置换术（TKA）中保留髌骨治疗髌股关节炎的临床和影像学结果，并根据髌股关节炎的严重程度进行分组。
我们回顾性分析了 2010 年 9 月至 2015 年 5 月期间使用 NexGen LPS 或 LPS-flex 系统行 TKA 并保留髌骨的患者。根据 Iwano 分类系统评估髌股关节炎的放射学严重程度，将患者分为轻度（0 期-I 期）和中重度（II-IV 期）组。采用 HSS 评分、膝关节协会评分、功能评分、WOMAC 指数和 Feller 评分评估临床结果。采用髌骨吻合角、髌骨倾斜角和外侧髌骨移位评估放射学结果。临床和放射学评估的最小随访时间为 2 年。比较两组患者术前和末次随访时的临床和放射学结果。
共纳入 474 例膝关节，分为轻度组（n=208）和中重度组（n=266）。中重度组术前 Feller 评分明显较低（P=0.030），但两组术后临床和放射学结果无明显差异。
至少 2 年随访时，保留髌骨的 TKA 治疗髌股关节炎的严重程度与临床和放射学结果无关。即使在髌股关节炎严重的患者中，保留髌骨的 TKA 也能获得良好的结果。
