Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Indiana Joint Replacement Institute, Indianapolis, Indiana.
J Arthroplasty. 2024 Aug;39(8S1):S65-S69. doi: 10.1016/j.arth.2024.01.055. Epub 2024 Feb 7.
Leaving the patella unresurfaced in total knee arthroplasty (TKA) has increased significantly over the past decade in the United States, likely due to modern patella-friendly implants, complications with resurfacing, and the knowledge that historical studies were scientifically confounded. This study evaluated revision-free survivorship out to 8.5 years in a cohort of contemporary primary TKAs with patella-friendly femoral components and unresurfaced patellae.
A total of 1,053 consecutive primary TKAs with unresurfaced patellae were retrospectively reviewed. A selective patellar nonresurfacing protocol was used for all cases. Kaplan-Meier survivorship estimates were calculated based on patellar revision and the latest follow-up. An aggressive lateral patellar facetectomy was performed in 78% (823 of 1,053) of cases. The cohort was 62% women and 43% American Society of Anesthesiologists physical status classification I or II with a mean age and body mass index of 65 years (range, 35 to 94) and 35 kg/m (range, 18 to 65), respectively.
A total of 4 (0.4%, 4 of 1,053) unresurfaced patellae were revised. Three were resurfaced as part of other procedures: 2 for global instability and one for aseptic loosening at a mean of 1.6 years; and one patella was resurfaced by an outside surgeon for unexplained pain. The all-cause revision-free survivorship estimate specifically related to the patella was 98.9% (95% confidence interval, 98 to 100) out to 8.5 years. No significant difference in survivorship was related to patellae with or without a lateral patellar facetectomy (99.5 versus 98.1%, P ≥ .191); however, 3 of 4 patellar revisions occurred in TKAs without a lateral patellar facetectomy (P = .035).
The results of this study demonstrate excellent revision-free survivorship related to unresurfaced patellae, particularly when a lateral facetectomy was performed. These early to midterm results using modern patella-friendly femoral components are promising and comparable to resurfaced patellae in the literature.
IV.
在过去十年中，美国全膝关节置换术中未对髌骨进行表面处理的情况显著增加，这可能是由于现代髌骨友好型植入物、表面处理相关并发症以及历史研究存在科学混淆的原因。本研究评估了一组使用髌骨友好型股骨组件和未表面处理髌骨的当代初次全膝关节置换术患者，随访时间长达 8.5 年的无翻修生存率。
回顾性分析了 1053 例连续初次未表面处理髌骨的全膝关节置换术患者。所有病例均采用选择性髌骨非表面处理方案。根据髌骨翻修和最新随访情况，计算 Kaplan-Meier 生存率估计值。78%（823/1053）的病例行激进的外侧髌骨面切除术。该队列中 62%为女性，43%为美国麻醉医师协会身体状况分类 I 或 II 级，平均年龄和体重指数分别为 65 岁（范围 35 岁至 94 岁）和 35kg/m²（范围 18kg/m² 至 65kg/m²）。
4 例（0.4%，4/1053）未表面处理的髌骨进行了翻修。其中 3 例因其他原因进行了表面处理：2 例为全膝关节置换术后不稳定，1 例为全膝关节置换术后无菌性松动，平均随访时间为 1.6 年；1 例髌骨由外部医生进行了表面处理，原因不明。专门针对髌骨的全因无翻修生存率估计值在 8.5 年内为 98.9%（95%置信区间，98%至 100%）。无明显差异与有无外侧髌骨面切除术的髌骨的生存率相关（99.5%比 98.1%，P≥.191）；然而，4 例髌骨翻修中有 3 例发生在未行外侧髌骨面切除术的全膝关节置换术中（P=.035）。
本研究结果表明，未表面处理的髌骨具有优异的无翻修生存率，特别是当行外侧髌骨面切除术时。这些使用现代髌骨友好型股骨组件的早期至中期结果很有希望，与文献中报道的髌骨表面处理结果相当。
IV 级。
