Department of Orthopaedic Surgery, University of Missouri, Columbia, MO.
J Arthroplasty. 2022 Aug;37(8S):S859-S863. doi: 10.1016/j.arth.2022.02.020. Epub 2022 Feb 11.
Non-optimal patellofemoral relationships may influence treatment decisions during revision total knee arthroplasty (TKA). We performed this study to determine whether patellar implant malposition or patellar tilt is associated with inferior patient-reported outcome scores or patient satisfaction after primary TKA.
We identified 396 TKA patients (439 knees) from an institutional registry who had undergone patellar resurfacing, with preoperative and 6-week postoperative radiographs available, and patient-reported outcome measures (PROMs) completed at least 1 year after surgery (mean 505 days). Preoperative patient demographic characteristics, patient-reported expectations, National Institutes of Health - Patient Reported Outcomes Measurements Instrument Systems global health, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and University of California Los Angeles activity scores were compared between 60 TKAs performed with non-optimal patellofemoral relationships (36 patellar implant malposition, 24 patellar tilt) and 379 TKAs performed with optimal patellar implant placement.
There were no differences between the 2 cohorts regarding demographic features, preoperative radiographic disease severity, expectations, and PROMs; or postoperative tibiofemoral component alignment, PROMs, and patient-reported satisfaction (P = .48). Knee Injury and Osteoarthritis Outcome Score for Joint Replacement improved similarly (P = .62) for patients with optimal resurfacing (48.5-77.6 points) and non-optimal resurfacing (47.7-76.6 points). A similar proportion of optimal and suboptimal resurfaced patients reported being satisfied with their TKA (92.7% vs 88.1%, P = .29).
Although suboptimal patellofemoral relationships may prompt treatment considerations during revision TKA, the data obtained from this study do not suggest that patellar implant malposition or patellar tilt independently contribute to postoperative pain, functional limitation, or dissatisfaction.
This is a level III, retrospective cohort study.
髌股关节关系不理想可能会影响翻修全膝关节置换术（TKA）时的治疗决策。我们进行这项研究是为了确定初次 TKA 后髌股关节假体位置不当或髌骨倾斜是否与患者报告的结局评分较低或患者满意度降低相关。
我们从一个机构数据库中确定了 396 例（439 膝）接受过髌骨表面置换术的 TKA 患者，这些患者均有术前和术后 6 周的 X 线片，且在术后至少 1 年（平均 505 天）时完成了患者报告的结局测量（PROM）。我们比较了 60 例髌股关节关系不理想（36 例髌骨假体位置不当，24 例髌骨倾斜）和 379 例髌股关节关系理想的 TKA 患者的术前患者人口统计学特征、患者报告的预期、美国国立卫生研究院患者报告结局测量系统整体健康评分、膝关节损伤和骨关节炎关节置换评分以及加利福尼亚大学洛杉矶活动评分。
两组患者在人口统计学特征、术前影像学疾病严重程度、预期和 PROM 方面，或术后胫股关节组件对线、PROM 和患者报告的满意度方面均无差异（P=0.48）。接受理想表面置换术（48.5-77.6 分）和不理想表面置换术（47.7-76.6 分）的患者，膝关节损伤和骨关节炎关节置换评分的改善情况相似（P=0.62）。理想和不理想表面置换术患者报告对 TKA 满意的比例相似（92.7%比 88.1%，P=0.29）。
尽管髌股关节关系不理想可能会促使在翻修 TKA 时考虑治疗，但本研究的数据并未表明髌股关节假体位置不当或髌骨倾斜会独立导致术后疼痛、功能受限或不满意。
这是一项 III 级回顾性队列研究。
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