Chen Kai, Dai Xiaoyu, Li Lidong, Chen Zhigang, Cui Haidong, Lv Shujun
Department of Orthopedic Surgery, Hai'an People's Hospital, Zhongba Road 17, Hai'an, Nantong, 226600, Jiangsu, People's Republic of China.
Department of Orthopedic Surgery, The First People's Hospital of Changzhou Affiliated to Soochow University, Juqian Road 185, Changzhou, 213000, Jiangsu, People's Republic of China.
J Orthop Surg Res. 2021 Jan 25;16(1):83. doi: 10.1186/s13018-020-02185-5.
Whether resurface the patella or not in total knee arthroplasty (TKA) was controversial. In 2013, we conducted a meta-analysis of randomized controlled trials (RTCs). After that, plenty of studies have been carried out, but there still existed a great deal of controversy. In order to update our previous study, we conducted this update meta-analysis to evaluate the efficacy of patellar resurfacing in TKA.
Databases were searched for RCTs comparing the outcomes of patellar resurfacing and nonresurfacing in TKA. Outcomes of knee relevant indicators were analysed. To see the short- and long-term effects, we calculated the data in total and divided the patients who were followed up for ≤ 3 years and ≥ 5 years into two subgroups as well.
Thirty-two trials assessing 6887 knees were eligible. There was a significant difference in terms of reoperation (in total and ≥ 5 years), Knee Society Score (KSS), function score (in total and ≥ 5 years) and noise. While no significant difference was found in the following items: reoperation (≤ 3 years), anterior knee pain (AKP), function score (≤ 3 years), range of motion (ROM), Oxford score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analogue score (VAS), Feller score, patellar tilt and the patients' satisfaction.
We found that patellar resurfacing could reduce the occurrence of reoperation and noise after surgery, as well as increase the KSS and function score, while it might not influence the outcomes such as AKP, ROM, Oxford score, KOOS, VAS, Feller score, patellar tilt and the patients' satisfaction. The results are different from our previous finding in the meta-analysis. In conclusion, we prefer patellar resurfacing in TKA.
在全膝关节置换术（TKA）中是否对髌骨进行表面置换存在争议。2013年，我们对随机对照试验（RCT）进行了一项荟萃分析。此后，开展了大量研究，但争议仍然很大。为了更新我们之前的研究，我们进行了这项更新的荟萃分析，以评估TKA中髌骨表面置换的疗效。
检索数据库以查找比较TKA中髌骨表面置换和未置换结果的RCT。分析膝关节相关指标的结果。为了观察短期和长期效果，我们汇总计算数据，并将随访时间≤3年和≥5年的患者分为两个亚组。
32项评估6887个膝关节的试验符合条件。在再次手术（总体和≥5年）、膝关节协会评分（KSS）、功能评分（总体和≥5年）和弹响方面存在显著差异。而在以下项目中未发现显著差异：再次手术（≤3年）、膝前疼痛（AKP）、功能评分（≤3年）、活动范围（ROM）、牛津评分、膝关节损伤和骨关节炎结局评分（KOOS）、视觉模拟评分（VAS）、费勒评分、髌骨倾斜度和患者满意度。
我们发现髌骨表面置换可以减少术后再次手术的发生和弹响，同时提高KSS和功能评分，而可能不会影响诸如AKP、ROM、牛津评分、KOOS、VAS、费勒评分、髌骨倾斜度和患者满意度等结果。结果与我们之前荟萃分析中的发现不同。总之，我们在TKA中更倾向于髌骨表面置换。
