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全膝关节置换术中的髌骨表面置换:一个有争议的问题。

Patellar Resurfacing in Total Knee Arthroplasty: A Contentious Matter.

作者信息

Upadhyay Prateek, Salwan Ankur, Kanani Kashyap, Koushik Ajay, Mittal Ankit, Goyal Saksham

机构信息

Orthopaedics and Trauma, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.

出版信息

Cureus. 2024 Oct 6;16(10):e70936. doi: 10.7759/cureus.70936. eCollection 2024 Oct.

Abstract

Orthopaedic surgeons hold differing opinions on replacing the patella during total knee arthroplasty (TKA) for knee osteoarthritis, sparking a continued discussion on the optimal approach. Patellar resurfacing (PR) replaces the patella's surface with a prosthetic component, aiming to enhance joint function and reduce anterior knee pain. However, it has potential complications such as avascular necrosis, fractures, and patellar clunk syndrome. This analysis evaluates the effectiveness of TKA with and without PR, highlighting the variations in outcomes between the two methods. Findings suggest that resurfacing is associated with improved clinical outcomes, activity level, patient satisfaction, and pain relief. Nevertheless, the decision should be individualized based on patient preferences and circumstances. Additional long-term randomised controlled trials incorporating outcome measures specific to patellar function are required to better understand the effects of PR versus non-resurfacing in TKA.

摘要

骨科医生对于在全膝关节置换术(TKA)治疗膝关节骨关节炎时是否置换髌骨持有不同意见,这引发了关于最佳方法的持续讨论。髌骨表面置换(PR)用假体部件替换髌骨表面,旨在增强关节功能并减轻膝关节前部疼痛。然而,它存在诸如缺血性坏死、骨折和髌骨卡顿综合征等潜在并发症。本分析评估了有或没有进行髌骨表面置换的全膝关节置换术的有效性,突出了两种方法在结果上的差异。研究结果表明,表面置换与改善临床结果、活动水平、患者满意度和疼痛缓解相关。尽管如此,应根据患者的偏好和具体情况进行个体化决策。需要进行更多纳入针对髌骨功能的特定结果指标的长期随机对照试验,以更好地了解在全膝关节置换术中髌骨表面置换与不置换的效果。

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本文引用的文献

1
Secondary Patellar Resurfacing Following Primary Unresurfaced Total Knee Arthroplasty: Beware of the Incidence of Late Patellar Erosion.
J Arthroplasty. 2024 Aug;39(8S1):S244-S247. doi: 10.1016/j.arth.2024.04.022. Epub 2024 Apr 15.
4
Patellar Resurfacing in Total Knee Arthroplasty, a Never-Ending Controversy; Case Report and Literature Review.
Diagnostics (Basel). 2023 Jan 19;13(3):383. doi: 10.3390/diagnostics13030383.
7
To Retain or Resurface the Patella in Primary Total Knee Arthroplasty: A Comparative Study.
Rev Bras Ortop (Sao Paulo). 2021 Mar 31;56(6):741-746. doi: 10.1055/s-0040-1721838. eCollection 2021 Dec.
10
Routine Patellar Resurfacing During Total Knee Arthroplasty Is Not Cost-Effective in Patients Without Patellar Arthritis.
J Arthroplasty. 2019 Sep;34(9):1963-1968. doi: 10.1016/j.arth.2019.04.040. Epub 2019 Apr 26.

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