Limberg Afton K, Tibbo Meagan E, Ollivier Matthieu, Tammachote Nattapol, Abdel Matthew P, Berry Daniel J
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Orthopedic Surgery, Aix-Marseille Université, Marseille, France.
J Bone Joint Surg Am. 2022 Mar 2;104(5):451-458. doi: 10.2106/JBJS.21.00356.
Patellar complications are a consequential cause of failure of primary total knee arthroplasty (TKA). The purpose of this study was to evaluate the association of demographic and patient factors with the long-term risk of patellar complications as a function of time in a very large cohort of primary TKAs performed with patellar resurfacing.
We identified 27,192 primary TKAs utilizing cemented all-polyethylene patellar components that were performed at a single institution from 1977 through 2015. We evaluated the risk of any aseptic patellar complication and any aseptic patellar reoperation or revision, subanalyzed risks of reoperation or revision for loosening, maltracking/instability, and wear, and evaluated the risk of clinical diagnosis of patellar fracture and clunk/crepitus. The mean age at TKA was 68 years (range, 18 to 99 years); 57% of the patients were female. The mean body mass index (BMI) was 32 kg/m2. The primary diagnosis was osteoarthritis in 83%, and 70% of the TKAs were posterior-stabilized. Median follow-up was 7 years (range, 2 to 40 years). Risk factors for each outcome were evaluated with Cox regression models.
Nine hundred and seventy-seven knees with all-polyethylene patellae developed patellar complications. Survivorship free from any aseptic patellar complication was 93.3% at 20 years. Twenty-year survivorship free from any aseptic patellar reoperation was 97.3% and free from any aseptic patellar revision was 97.4%. Fifteen-year survivorship for the same end points for procedures performed from 2000 to 2015 was 95.7%, 99.2% and 99.3% respectively, representing substantial improvements compared with implants placed before 2000. Univariate analysis demonstrated that male sex (hazard ratio [HR], 1.4), an age of <65 years (HR, 1.3), and a BMI of ≥30 kg/m2 (HR, 1.2) were associated with increased risk of patellar complications (all p ≤0.01). Posterior-stabilized designs were associated with fewer patellar reoperations and revisions overall (HR, 0.4 and 0.4; p < 0.001) but higher risk of patellar clunk/crepitus (HR, 14.1; p < 0.001).
The 20-year survivorship free from any aseptic patellar complication in this series of cemented all-polyethylene patellae was 93%. Important risk factors for any aseptic patellar complication were male sex, an age of <65 years, a BMI of ≥30 kg/m2, and a patella implanted before 2000.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
髌骨并发症是初次全膝关节置换术（TKA）失败的一个重要原因。本研究的目的是在一组进行髌骨表面置换的大型初次TKA队列中，评估人口统计学和患者因素与髌骨并发症长期风险随时间变化的关系。
我们确定了1977年至2015年在单一机构进行的27192例使用骨水泥固定的全聚乙烯髌骨组件的初次TKA。我们评估了任何无菌性髌骨并发症以及任何无菌性髌骨再次手术或翻修的风险，对因松动、轨迹不良/不稳定和磨损进行再次手术或翻修的风险进行了亚组分析，并评估了髌骨骨折和卡顿/摩擦音临床诊断的风险。TKA时的平均年龄为68岁（范围18至99岁）；57%的患者为女性。平均体重指数（BMI）为32kg/m²。主要诊断为骨关节炎的占83%，70%的TKA为后稳定型。中位随访时间为7年（范围2至40年）。使用Cox回归模型评估每种结局的危险因素。
977例使用全聚乙烯髌骨的膝关节出现了髌骨并发症。20年时无任何无菌性髌骨并发症的生存率为93.3%。20年时无任何无菌性髌骨再次手术的生存率为97.3%，无任何无菌性髌骨翻修的生存率为97.4%。2000年至2015年进行的手术在相同终点的15年生存率分别为95.7%、99.2%和99.3%，与2000年前植入的假体相比有显著改善。单因素分析表明，男性（风险比[HR]，1.4）、年龄<65岁（HR，1.3）和BMI≥30kg/m²（HR，1.2）与髌骨并发症风险增加相关（所有p≤0.01）。总体而言，后稳定型设计与较少的髌骨再次手术和翻修相关（HR，0.4和0.4；p<0.001），但髌骨卡顿/摩擦音风险较高（HR，14.1；p<0.001）。
在这组骨水泥固定的全聚乙烯髌骨系列中，20年时无任何无菌性髌骨并发症的生存率为93%。任何无菌性髌骨并发症的重要危险因素为男性、年龄<65岁、BMI≥30kg/m²以及2000年前植入的髌骨。
预后IV级。有关证据水平的完整描述，请参阅作者指南。
Zotero 插件