Health Education and Improvement Wales, Tu Dysgu, Cefn Coed, Nantgarw, CF15 7QQ, UK.
Trauma and Orthopaedics Department, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, NP20 2UB, UK.
Eur J Orthop Surg Traumatol. 2024 May;34(4):2015-2019. doi: 10.1007/s00590-024-03880-3. Epub 2024 Mar 22.
We have previously reported our experience of the effect of complete excision of Hoffa's fat pad on patella height post TKR. In this study, we compared the change of patellar height post TKR before and after the senior author changed his practice to preserving Hoffa's fat pad.
This was a retrospective analysis of a prospective series of TKRs performed or directly supervised by the senior author. In Group 1 were 72 patients performed before April 2011 who had complete excision of Hoffa's fat pad to maximise exposure during the procedure. In Group 2 were 138 patients performed after April 2011 who had the minimum excision of Hoffa's fat pad to allow adequate surgical exposure. The surgical technique and rehabilitation protocol were identical in all other respects. Patellar height was assessed using the Caton-Deschamps Index both immediately postoperative and at a minimum follow up of 1 year.
Group 1 included 28 males, 44 females with mean age 68.36 years. The mean CDI in this group changed from 0.54 immediately post-operatively to 0.46 at minimum one year follow-up (P = 0.001) indicating progressive patella baja. Group 2 included 56 males, 82 females with mean age 65 years. The mean CDI changed from 0.67 immediately post-operative to 0.68 at minimum one year post follow-up (P = 0.32) indicating no statistically or clinically relevant post-operative change in patellar height.
Total excision of Hoffa's fat pad is associated with progressive post-operative patella baja. This can be avoided by resecting the minimum amount of fat pad to allow adequate exposure during the procedure.
我们之前报道过全切除髌下脂肪垫对 TKR 后髌骨高度的影响。在这项研究中，我们比较了在高级作者改变手术方式保留髌下脂肪垫前后 TKR 后髌骨高度的变化。
这是一项前瞻性系列 TKR 的回顾性分析，由高级作者直接进行或监督。在组 1 中，有 72 例患者在 2011 年 4 月前完成手术，在手术过程中完全切除髌下脂肪垫以最大限度地暴露。在组 2 中，有 138 例患者在 2011 年 4 月后完成手术，仅切除最小量的髌下脂肪垫以保证足够的手术暴露。在其他方面，手术技术和康复方案完全相同。髌骨高度采用 Caton-Deschamps 指数（CDI）进行评估，术后即刻和至少 1 年随访时进行评估。
组 1 包括 28 名男性和 44 名女性，平均年龄为 68.36 岁。该组的平均 CDI 从术后即刻的 0.54 变为 1 年随访时的 0.46（P=0.001），表明髌骨逐渐下降。组 2 包括 56 名男性和 82 名女性，平均年龄为 65 岁。平均 CDI 从术后即刻的 0.67 变为 1 年随访时的 0.68（P=0.32），表明髌骨高度在术后没有统计学或临床上相关的变化。
髌下脂肪垫的完全切除与术后髌骨逐渐下降有关。通过切除最小量的脂肪垫以保证手术过程中充分暴露，可以避免这种情况。
