Malahias Michael-Alexander, Chytas Dimitrios, Thorey Fritz
ATOS Hospital Heidelberg, International Center for Hip, Knee and Foot Surgery, Heidelberg, Germany.
National and Kapodistrian University of Athens, School of Medicine, 2 Orthopedic Department, Athens, Greece.
Orthop Rev (Pavia). 2018 Jun 14;10(2):7531. doi: 10.4081/or.2018.7531.
The focal metallic cartilage resurfacing is a surgical method that offers an appropriate between the biological techniques and arthroplasty in middle-aged patients with full-thickness cartilage defects. The advantages of this technique are that it addresses the defect, respects healthy tissues and provides stability and contoured surface similar to a full arthroplasty. A systematic review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers (MM and DC) independently conducted the search using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews (CDSR). These databases were searched for the terms and and . From the initial 21 studies that were evaluated, 10 were eligible for analysis. Considering both the HemiCAP focal implant and the HemiCap Wave patellofemoral prosthesis, we found a lack of mid- to long-term clinical outcomes in well-designed prospective clinical studies. No Level I or II studies were found, while the limited number of patients who were included undermines the overall clinical results of these studies. The progression of osteoarthritis, the persisting pain and the subsequent high revision or failure rates in the limited available studies with long-term follow-up, seem to be the major drawbacks of these partial resurfacing techniques. Utilization of partial resurfacing for femoral or patellofemoral compartments results in good short-term outcome for middle-aged patients as a between biological technique and total knee arthroplasty. The surgeon should be cognizant and also notify the patient of the high failure rates that are reported in the literature in mid- to longterm follow-up and ultimately, the decision to perform partial resurfacing should be taken by both the patient and the orthopedic surgeon.
局灶性金属软骨表面置换术是一种手术方法,它在中年全层软骨缺损患者中,为生物治疗技术和关节置换术之间提供了一种合适的选择。该技术的优点在于它能解决缺损问题,尊重健康组织,并提供与全关节置换术相似的稳定性和轮廓表面。根据系统评价和Meta分析的首选报告项目(PRISMA)指南进行了一项系统评价。两名评价者(MM和DC)独立使用MEDLINE/PubMed数据库和Cochrane系统评价数据库(CDSR)进行检索。在这些数据库中检索了相关术语。从最初评估的21项研究中,有10项符合分析条件。考虑到半帽局灶性植入物和半帽Wave髌股假体,我们发现在设计良好的前瞻性临床研究中缺乏中长期临床结果。未发现I级或II级研究,而纳入患者数量有限削弱了这些研究的总体临床结果。在有限的长期随访可用研究中,骨关节炎的进展、持续疼痛以及随后较高的翻修率或失败率,似乎是这些部分表面置换技术的主要缺点。对于中年患者,作为生物治疗技术和全膝关节置换术之间的一种选择,股骨或髌股关节腔的部分表面置换术可带来良好的短期结果。外科医生应认识到并告知患者文献中报道的中长期随访中的高失败率,最终,部分表面置换术的决定应由患者和骨科医生共同做出。