Woelfle Catelyn A, Cooper H John
Department of Orthopedic Surgery, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA.
Arthroplast Today. 2024 Nov 18;30:101563. doi: 10.1016/j.artd.2024.101563. eCollection 2024 Dec.
Routine patellar resurfacing remains controversial in primary total knee arthroplasty (TKA). This study reports the experience of a high-volume arthroplasty surgeon who stopped routinely resurfacing patellae for a 3-year period.
All primary TKAs performed by a single surgeon between January 2018 and September 2022 with minimum 1-year follow-up were retrospectively reviewed. Data were analyzed between cohorts-nonresurfaced and resurfaced patellae-and between phases-universal and selective resurfacing. Outcomes included reoperation, patellar complications, and patient-related outcome measure scores.
Five hundred four primary TKAs, with mean 24-month follow-up, were included. Patellar resurfacing was performed in 77% of the overall cohort, including 58% in the selective and 100% in the universal phases. Reoperation (7.6% vs 0.3%; < .001) and patellar complications (8.4% vs 1.3%; < .001) were higher in the nonresurfaced vs resurfaced cohort. Eight of the 9 reoperations in the nonresurfaced group were for secondary resurfacing, and all were female ( = .017). Mean 12-Item Short Form Health Survey Physical Health ( = .037) and Western Ontario and McMaster Universities Arthritis Index Pain scores ( = .002) were better in the resurfaced cohort. Selective resurfacing demonstrated a higher reoperation rate (3.3% vs 0.4%; = .022) and worse Western Ontario and McMaster Universities Arthritis Index Pain ( = .026) and Knee Society Knee Functional scores ( = .042).
Cessation of routine patellar resurfacing led to inferior clinical results and an unacceptably high early reoperation rate, specifically among women. The generalizability of these findings may be limited due to surgeon-specific factors; however, we urge caution in surgeons who consider similar changes in practice.
Level III.
在初次全膝关节置换术（TKA）中，常规髌骨表面置换仍存在争议。本研究报告了一位高手术量的关节置换外科医生在3年期间停止常规髌骨表面置换的经验。
回顾性分析了2018年1月至2022年9月期间由同一外科医生进行的所有初次TKA手术，且随访时间至少为1年。对未进行表面置换和进行了表面置换的髌骨队列以及普遍表面置换和选择性表面置换阶段的数据进行了分析。结果包括再次手术、髌骨并发症以及患者相关结局测量得分。
纳入了504例初次TKA手术，平均随访24个月。总体队列中77%的患者进行了髌骨表面置换，其中选择性表面置换阶段为58%，普遍表面置换阶段为100%。未进行表面置换的队列与进行了表面置换的队列相比，再次手术率（7.6%对0.3%；P <.001）和髌骨并发症发生率（8.4%对1.3%；P <.001）更高。未进行表面置换组的9例再次手术中有8例是为了二次表面置换，且均为女性（P = 0.017）。进行了表面置换的队列在12项简短健康调查问卷的身体健康方面（P = 0.037）以及西安大略和麦克马斯特大学骨关节炎指数疼痛评分方面（P = 0.002）表现更好。选择性表面置换显示出更高的再次手术率（3.3%对0.4%；P = 0.022）以及更差的西安大略和麦克马斯特大学骨关节炎指数疼痛评分（P = 0.026）和膝关节协会膝关节功能评分（P = 0.042）。
停止常规髌骨表面置换导致临床结果较差，早期再次手术率高得令人无法接受，尤其是在女性患者中。由于外科医生的特定因素，这些发现的可推广性可能有限；然而，我们敦促考虑在实践中进行类似改变的外科医生谨慎行事。
三级。
