Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2023 Jul;38(7 Suppl 2):S9-S14. doi: 10.1016/j.arth.2023.02.006. Epub 2023 Feb 10.
Whether to resurface the patella during total knee arthroplasty (TKA) remains debated. One often cited reason for not resurfacing is inadequate patellar thickness. The aim of this study was to describe the implant survivorships, reoperations, complications and clinical outcomes in patients who underwent patellar resurfacing of a thin native patella.
From 2000 to 2010, 7,477 patients underwent primary TKA with patellar resurfacing and had an intraoperatively, caliper-measured patella thickness at our institution. Of these, 200 (2.7%) had a preresection patellar thickness of ≤19 millimeters (mm). Mean preresection thickness was 18 mm (range, 12-19). Mean age was 69 years, mean body mass index was 31 kg/m, and 93% of the patients were women. Median follow-up was 10 years (range, 2-20).
At 10 years, survivorships free of any patella revision, patella-related reoperation, and periprosthetic patella fracture were 98%, 98%, and 99%, respectively. There were 3 patella revisions (1 aseptic loosening, 2 periprosthetic joint infections). There were 2 additional patella-related reoperations for patellar clunk. There were 3 nonoperatively managed periprosthetic patella fractures. Radiographically, all nonrevised knees had well-fixed patellae. Knee society scores improved from mean 36 points (interquartile range [IQR] 24-49) preoperatively to mean 81 points (IQR 77-81) at 10-year follow-up.
Resurfacing the thin native patella was associated with high survivorship free of patellar revision at 10-year follow-up. Nevertheless, there was 1 case of patellar loosening and 3 periprosthetic patella fractures. These risks must be weighed against the known higher incidence of revision when the thin native patella is left unresurfaced.
在全膝关节置换术（TKA）中是否需要修复髌骨仍存在争议。一个常见的不修复髌骨的原因是髌骨厚度不足。本研究的目的是描述在髌骨厚度较薄的患者中进行髌骨修复后的假体存活率、翻修手术、并发症和临床结果。
2000 年至 2010 年，7477 例患者在我院行初次 TKA 髌骨表面置换术，术中用卡尺测量髌骨厚度。其中 200 例（2.7%）髌骨预切除厚度≤19 毫米（mm）。平均预切除厚度为 18 毫米（范围 12-19）。平均年龄 69 岁，平均体重指数 31kg/m，93%的患者为女性。中位随访时间为 10 年（范围 2-20）。
10 年时，无任何髌骨翻修、髌骨相关翻修和假体周围髌骨骨折的生存率分别为 98%、98%和 99%。有 3 例髌骨翻修（1 例无菌性松动，2 例假体周围关节感染）。另有 2 例髌骨相关翻修为髌骨弹响。有 3 例非手术治疗的假体周围髌骨骨折。影像学上，所有未翻修的膝关节髌骨均固定良好。膝关节协会评分从术前平均 36 分（四分位距[IQR]24-49）改善至 10 年随访时的平均 81 分（IQR 77-81）。
在 10 年随访时，修复较薄的髌骨与髌骨翻修率低有关。然而，有 1 例髌骨松动和 3 例假体周围髌骨骨折。这些风险必须与不修复较薄的髌骨时已知更高的翻修发生率相权衡。
