Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea.
J Arthroplasty. 2023 Sep;38(9):1742-1747. doi: 10.1016/j.arth.2023.03.056. Epub 2023 Mar 24.
Various patellar designs are used in total knee arthroplasty (TKA) for optimal management of patellofemoral pain. The aim of this study was to compare postoperative 2-year clinical outcomes of 3 patellar designs: medialized anatomic (MA), medialized dome (MD), and Gaussian dome (GD).
In this randomized controlled trial, 153 patients undergoing primary TKA from 2015 to 2019 were enrolled. Patients were allocated to 3 groups (MA, MD, and GD). Demographic characteristics, clinical variables including knee flexion angle and patient-reported outcome measures (Kujala score, Knee Society Scores, the Hospital for Special Surgery score, and The Western Ontario and McMaster Universities Arthritis Index), and complications were collected. Radiologic parameters including Blackburne-Peel ratio and patellar tilt angle (PTA) were measured. A total of 139 patients who completed postoperative follow-up for 2 years were analyzed.
Knee flexion angle and patient-reported outcome measures did not statistically differ among the 3 groups (MA, MD, and GD). There were no extensor mechanism-related complications at any group. Group MA showed significantly higher mean values of postoperative PTA than group GD (0.1 ± 3.2 versus -1.8 ± 3.4, P = .011). Group GD (20.8%) had a tendency to have more outliers (over 5 degrees) in PTA than groups MA (10.6%) and MD (4.5%), although the differences were not statistically significant (P = .092).
Anatomic patellar design was not clinically superior over dome design in TKA, showing comparable results in terms of clinical scores, complications, and radiographic indices.
在全膝关节置换术（TKA）中，为了优化髌股疼痛的管理，使用了各种髌骨设计。本研究的目的是比较 3 种髌骨设计（内侧解剖型、内侧穹隆型和高斯穹隆型）在 TKA 术后 2 年的临床结果。
在这项随机对照试验中，纳入了 2015 年至 2019 年期间接受初次 TKA 的 153 例患者。患者被分配到 3 组（MA、MD 和 GD）。收集了人口统计学特征、临床变量（包括膝关节屈曲角度和患者报告的结局测量指标[Kujala 评分、膝关节协会评分、特殊外科医院评分和西安大略和麦克马斯特大学关节炎指数]）和并发症。测量了放射学参数，包括 Blackburne-Peel 比值和髌骨倾斜角（PTA）。共有 139 例患者完成了术后 2 年的随访，对其进行了分析。
3 组（MA、MD 和 GD）之间的膝关节屈曲角度和患者报告的结局测量指标没有统计学差异。任何一组均无伸肌机制相关并发症。MA 组的术后 PTA 平均值明显高于 GD 组（0.1±3.2 与-1.8±3.4，P=0.011）。与 MA 组（10.6%）和 MD 组（4.5%）相比，GD 组（20.8%）的 PTA 偏倚度更大（超过 5 度），尽管差异无统计学意义（P=0.092）。
在 TKA 中，解剖型髌骨设计并不优于穹隆型设计，在临床评分、并发症和影像学指标方面均具有相似的结果。
