二期翻修全膝关节置换术治疗假体周围关节感染时髌骨的结局和相关性。
The Fate and Relevance of the Patella in Two-Stage Revision Total Knee Arthroplasty for Periprosthetic Joint Infection.
机构信息
Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, Indiana.
Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
出版信息
J Arthroplasty. 2022 Oct;37(10):2090-2096. doi: 10.1016/j.arth.2022.05.004. Epub 2022 May 6.
BACKGROUND
It remains unclear whether reimplantation of a patellar component during a two-stage revision for periprosthetic total knee arthroplasty infection (PJI) affects patient reported outcome measures (PROMs) or implant survivorship. The purpose of this study was to evaluate whether patellar resurfacing during reimplantation confers a functional benefit or increases implant survivorship after two-stage treatment for PJI.
METHODS
Two-stage revisions for knee PJI performed by three surgeons at a single tertiary care center were reviewed retrospectively. All original patellar components and cement were removed during resection and the patella was resurfaced whenever feasible during reimplantation. PROMs, implant survivorship, and radiographic measurements (patellar tilt and displacement) were compared between knees reimplanted with a patellar component versus those without a patellar component.
RESULTS
A total of 103 patients met the inclusion criteria. Forty-three patients (41.7%) underwent reimplantation with, and 60 patients (58.3%) without a patellar component. At a mean follow-up of 33.5 months, there were no significant differences in patient demographics or PROMs between groups (P ≥ .156). No significant differences were found in the estimated Kaplan-Meier all-cause, aseptic, or septic survivorship between groups (P ≥ .342) at a maximum of 75 months follow-up. There was no significant difference in the change (pre-resection to post-reimplant) of patellar tilt (P = .504) or displacement (P = .097) between the groups.
CONCLUSION
Patellar resurfacing during knee reimplantation does not appear to meaningfully impact postoperative PROMs or survivorship. Given the risk of potential extensor mechanism complications with patellar resurfacing, surgeons may choose to leave the patella without an implant during total knee reimplantation and expect similar clinical outcomes.
LEVEL OF EVIDENCE
Level III.
背景
在二期翻修治疗人工膝关节置换术后感染（PJI）时，是否重新植入髌骨组件会影响患者报告的结局测量（PROM）或植入物存活率，目前尚不清楚。本研究旨在评估在二期治疗 PJI 时重新植入髌骨是否会带来功能益处或增加植入物存活率。
方法
回顾性分析了一家三级保健中心的 3 位外科医生进行的膝关节 PJI 二期翻修。在切除过程中，所有原始髌骨组件和骨水泥均被清除，只要在重新植入时可行，髌骨均被重新覆盖。比较了重新植入髌骨组件的膝关节与未植入髌骨组件的膝关节之间的 PROM、植入物存活率和影像学测量（髌骨倾斜和髌骨移位）。
结果
共有 103 例患者符合纳入标准。43 例（41.7%）患者接受了髌骨组件重新植入，60 例（58.3%）患者未植入髌骨组件。平均随访 33.5 个月，两组患者的人口统计学资料或 PROM 无显著差异（P≥.156）。在最多 75 个月的随访中，两组之间在全因、无菌和感染性存活率的估计 Kaplan-Meier 方面没有发现显著差异（P≥.342）。两组之间的髌骨倾斜（P=0.504）或髌骨移位（P=0.097）的变化（术前至术后再植入）无显著差异。
结论
在膝关节重新植入时对髌骨进行表面处理似乎不会对术后 PROM 或存活率产生重大影响。鉴于髌骨表面处理可能会增加伸肌机制并发症的风险，外科医生可能会选择在全膝关节重新植入时不植入髌骨，并期望获得类似的临床结果。
证据水平
III 级。
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