Jones Gareth G, Campi Stefano, von Knoch Fabian, Lunebourg Alexandre, London Nick, Barrett David, Argenson Jean-Noel
MSk Lab, Imperial College London, London, UK.
Campus Bio Medico University Hospital, Rome, Italy.
Arch Orthop Trauma Surg. 2025 Jan 11;145(1):120. doi: 10.1007/s00402-024-05738-z.
The aim of this study was to establish an international consensus statement on the indications for the addition of a patellofemoral joint arthroplasty (PFJA) in patients with a unicondylar knee arthroplasty (UKA) and symptomatic progression of patellofemoral compartment osteoarthritis.
A systematic review of the literature was conducted, and the results used to inform the development of a statement by an expert working group. This was then evaluated and modified, using a Delphi process, by members of the European Knee Society (EKS).
Forty-nine (round one) and forty-two (round two) EKS members took part in the Delphi process, with 83% agreement on the resulting consensus statement that the indications for this procedure are: (1) a well-functioning UKA in a satisfied patient with secondary osteoarthritis progression in the patellofemoral compartment (2), symptomatic patellofemoral compartment osteoarthritis with full thickness cartilage loss affecting the lateral facet of the patellofemoral joint (3), functional ligaments, including the anterior cruciate ligament (ACL) (4), a lateral tibiofemoral compartment with no cartilage damage greater than Ahlback Grade 1 (5), knee flexion ≥ 100° and extension loss ≤ 5° and (6) older patients with increased medical co-morbidities.
The simple addition of a PFJA to patients with an existing UKA and progression of patellofemoral compartment osteoarthritis is an attractive option. This EKS Delphi-derived consensus statement, which reached a strong consensus, can be used by clinicians to identify patients suitable for this procedure.
本研究的目的是就单髁膝关节置换术（UKA）患者合并髌股关节骨关节炎症状性进展时，增加髌股关节置换术（PFJA）的适应症达成国际共识声明。
进行了文献系统综述，结果用于为专家工作组制定声明提供参考。然后，欧洲膝关节学会（EKS）成员通过德尔菲法对该声明进行评估和修改。
49名（第一轮）和42名（第二轮）EKS成员参与了德尔菲法，83%的成员对最终达成的共识声明表示认同，该手术的适应症为：（1）UKA功能良好，患者满意，伴有髌股关节间室继发性骨关节炎进展；（2）有症状的髌股关节间室骨关节炎，髌股关节外侧小面全层软骨缺失；（3）包括前交叉韧带（ACL）在内的韧带功能正常；（4）胫股外侧间室软骨损伤不超过阿尔贝克1级；（5）膝关节屈曲≥100°且伸直受限≤5°；（6）合并症较多的老年患者。
对于已有UKA且髌股关节间室骨关节炎进展的患者，单纯增加PFJA是一个有吸引力的选择。这份由EKS德尔菲法得出的达成强烈共识的共识声明，可供临床医生用于识别适合该手术的患者。
