Croydon University Hospital, 530 London Road, Thornton Heath, CR7 7YE, UK.
Academic Surgical Unit, South West London Elective Orthopaedic Centre, Dorking Road, Epsom, KT18 7EG, UK.
Arch Orthop Trauma Surg. 2023 Aug;143(8):5333-5343. doi: 10.1007/s00402-022-04733-6. Epub 2023 Jan 25.
The primary aim was to assess the Oxford knee scores (OKS) on patients who underwent a total knee arthroplasty (TKA) with patellar resurfacing compared to those who did not. Secondary aims were to identify: (1) factors associated with resurfacing, (2) the effect of resurfacing on specific components of the OKS related to patellofemoral function, (3) the influence on patient satisfaction, and (4) whether a subgroup of patients had an improved outcome when resurfacing was undertaken.
A retrospective cohort study was undertaken using outcome data from the arthroplasty database held at the study centre. Patient demographics and OKS were collected preoperatively and at 1 and 2 years postoperatively. Patient satisfaction was assessed at 1 and 2 years postoperatively.
Three thousand one hundred and twenty-two patients met the inclusion criteria of which 46.5% (n = 1453) underwent resurfacing. There were no differences in the OKS change at 1 or 2 years between those undergoing and not undergoing resurfacing (difference 0.2, p ≥ 0.469). Patients undergoing resurfacing were more likely to be female (odds ratio (OR) 1.53, 95% CI 1.30-1.79, p < 0.001), undergo a posterior stabilised knee (OR 6.87, 95% CI 5.71-8.27, p < 0.001) or had a worse response to question 5-standing from a chair, (p = 0.011) or 12-stair descent, (p = 0.017) of the OKS preoperatively. There was no difference in postoperative patient satisfaction (p ≥ 0.180). There was a significantly greater improvement in question 12 of the OKS at 1 year (p = 0.019) in the resurfaced group. There were no patient-related factors or symptoms that were associated with a clinically significant (≥ 5 points) greater postoperative OKS.
Patella resurfacing was not associated with a clinically important improvement in OKS. No specific indications for patella resurfacing were identified that offered an improved outcome, but when it was undertaken there was a greater improvement in the ability to descend stairs. Level of evidence Retrospective diagnostic study, Level III.
本研究的主要目的是评估全膝关节置换术（TKA）中髌骨表面置换与未置换患者的牛津膝关节评分（OKS）。次要目的是确定：（1）与置换相关的因素；（2）置换对 OKS 中与髌股关节功能相关的特定成分的影响；（3）对患者满意度的影响；（4）当进行髌骨表面置换时，是否有亚组患者的预后得到改善。
采用回顾性队列研究，使用研究中心关节置换数据库中的结局数据。收集患者术前和术后 1 年及 2 年的人口统计学数据和 OKS。术后 1 年和 2 年评估患者满意度。
符合纳入标准的 3122 名患者中，46.5%（n=1453）接受了髌骨表面置换。在术后 1 年和 2 年时，接受和未接受髌骨表面置换的患者 OKS 变化无差异（差异 0.2，p≥0.469）。接受髌骨表面置换的患者更可能为女性（优势比（OR）1.53，95%置信区间（CI）1.30-1.79，p<0.001），行后稳定型膝关节（OR 6.87，95% CI 5.71-8.27，p<0.001）或术前 OKS 中第 5 题（从椅子上站立）或第 12 题（下楼梯）的反应较差（p=0.011）或 12 个楼梯下降（p=0.017）。术后患者满意度无差异（p≥0.180）。在术后 1 年时，OKS 的第 12 题有显著的更大改善（p=0.019）。没有与术后 OKS 显著改善（≥5 分）相关的患者相关因素或症状。
髌骨表面置换与 OKS 的临床重要改善无关。未确定髌骨表面置换的具体适应证，其可提供更好的结果，但当进行髌骨表面置换时，下楼梯的能力有更大的改善。证据水平回顾性诊断研究，III 级。
