与关节面切除术相比，髌股关节置换术在治疗孤立性髌股关节炎时具有相似的长期生存率和并发症，且临床效果更好。
Patellofemoral arthroplasty provides similar long-term survival rate and complications with better clinical outcomes compared to facetectomy for the treatment of isolated patellofemoral osteoarthritis.
作者信息
Martinez-Lozano J, Martorell-de Fortuny L, Martin-Domínguez L A, Torres-Claramunt R, Sánchez-Soler J, Perelli S, Hinarejos P, Monllau J C
机构信息
Orthopaedic Department, Hospital del Mar Universitat Autònoma Barcelona Barcelona Spain.
ICATKnee, Institut Català de Traumatologia i Medicina de l'Esport (ICATME), Hospital Universitari Dexeus Universitat Autònoma Barcelona Barcelona Spain.
出版信息
J Exp Orthop. 2025 Jan 10;12(1):e70136. doi: 10.1002/jeo2.70136. eCollection 2025 Jan.
PURPOSE
This study aimed to analyse the clinical outcomes and survival of patellofemoral arthroplasty (PFA) in treating isolated patellofemoral osteoarthritis (IPFOA) at our centre. The secondary objective was to compare these results with a historical cohort treated with partial lateral facetectomy plus Insall realignment (PLFIR). We hypothesised that clinical outcomes and survival with PFA are superior to PLFIR and comparable to the literature.
METHODS
A retrospective analysis of 120 patients with IPFOA was conducted. The PFA series included 33 patients treated between 2012 and 2019 with a minimum follow-up of 5 years (range 1.2-12.1 years). The PLFIR historical cohort treated between 1995 and 2002 (range 4.1-15.7 years) consisted of 87 patients. Preoperative and post-operative clinical outcomes were assessed using the Knee Society Score (KSS) and Kujala score, and survivorship was evaluated via Kaplan-Meier analysis. Cox regression analysis was used to identify factors influencing surgical failure.
RESULTS
The PFA group demonstrated a 75.8% survival rate at 10 years, with a 24.2% failure rate requiring conversion to total knee arthroplasty (TKA). In the PLFIR group, the 10-year survival rate was 79.3%, although 26.4% required TKA. Both groups exhibited significant improvements in KSS and Kujala score, with PFA showing superior Kujala score improvement ( = 0.012). No statistically significant difference in survival between the two groups was observed at 10 years ( = 0.056), but PFA showed better long-term clinical outcomes.
CONCLUSIONS
PFA demonstrated comparable survival rates to PLFIR in the treatment of IPFOA. Despite a higher initial failure rate, PFA showed a potential for greater improvement in the long term, particularly in terms of anterior knee pain.
LEVEL OF EVIDENCE
Level IV, retrospective case series analysis compared with a historical cohort.
目的
本研究旨在分析在我们中心采用髌股关节置换术（PFA）治疗孤立性髌股关节炎（IPFOA）的临床疗效和生存率。次要目标是将这些结果与接受部分外侧半月板切除术加Insall重新排列术（PLFIR）治疗的历史队列进行比较。我们假设PFA的临床疗效和生存率优于PLFIR，且与文献报道相当。
方法
对120例IPFOA患者进行回顾性分析。PFA组包括2012年至2019年期间接受治疗的33例患者，最小随访时间为5年（范围1.2 - 12.1年）。1995年至2002年期间接受治疗的PLFIR历史队列（范围4.1 - 15.7年）由87例患者组成。使用膝关节协会评分（KSS）和库贾拉评分评估术前和术后的临床疗效，并通过Kaplan-Meier分析评估生存率。采用Cox回归分析确定影响手术失败的因素。
结果
PFA组在10年时的生存率为75.8%，有24.2%的失败率需要转换为全膝关节置换术（TKA）。在PLFIR组中，10年生存率为79.3%，尽管有26.4%的患者需要TKA。两组的KSS和库贾拉评分均有显著改善，PFA组的库贾拉评分改善更优（P = 0.012）。两组在10年时生存率无统计学显著差异（P = 0.056），但PFA组显示出更好的长期临床疗效。
结论
在治疗IPFOA方面，PFA的生存率与PLFIR相当。尽管初始失败率较高，但PFA在长期显示出更大的改善潜力，特别是在前膝痛方面。
证据水平
IV级，与历史队列比较的回顾性病例系列分析。
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