Kuljic Nebojsa, Tyndall Wyatt, Thatcher Michael, Nickol Michaela, van der Merwe Johannes M
Department of Orthopaedic Surgery, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
J Orthop. 2024 Dec 18;67:7-13. doi: 10.1016/j.jor.2024.12.016. eCollection 2025 Sep.
Total knee replacements are becoming more prevalent. There is still a lot of controversy regarding patellar resurfacing. Surgeons advocating for resurfacing state reduced risk for anterior knee pain and need for future revision surgery. Our goal was to determine if patients would have similar outcomes if the patella is left unresurfaced or resurfaced with a medial congruent liner design.
A multi-surgeon retrospective chart review was conducted in a tertiary academic center, to identify all patients who received a total knee arthroplasty utilizing a medial congruent (MC) polyethylene liner between January 1, 2020 to December 31, 2020. All included patients were subsequently sent a survey package via mail to complete. Patients who did not return mail packages were contacted via phone.
We included 188 patients in the final analysis. There was no statistical difference between the groups in regards to age (p = 0.77), sex (p = 0.075), BMI (p = 0.22), hospital stay (p = 0.86), laterality (p = 0.51), ASA score (p = 0.52), Kellgren Lawrence medial compartment OA score (p = 0.33) and Kellgren Lawrence lateral compartment OA score (p = 0.49). There was a statistically significant difference in favour of the control group (patella not resurfaced) with the KOOS JR score (p = 0.045). This difference was not observed with the Kujala score (p = 0.98) and the Oxford knee score (0.89).
There might be a role in performing a patella resurfacing, even in newer total knee designs. We did not observe a clinically meaningful difference in PROMS between PR and non-PR TKA at medium-term follow-up. In addition, we did not observe any demographic factors that influenced the surgeon's decision to perform patella resurfacing. Further high-quality research is warranted.
全膝关节置换术越来越普遍。关于髌骨表面置换仍存在很多争议。主张进行表面置换的外科医生表示，可降低前膝痛风险以及未来翻修手术的必要性。我们的目标是确定，如果不进行髌骨表面置换或采用内侧匹配衬垫设计进行表面置换，患者是否会有相似的结果。
在一家三级学术中心进行了一项多外科医生回顾性病历审查，以确定2020年1月1日至2020年12月31日期间所有使用内侧匹配（MC）聚乙烯衬垫进行全膝关节置换术的患者。随后，向所有纳入的患者邮寄了一份调查问卷包以供填写。未回复邮件包的患者通过电话联系。
最终分析纳入了188例患者。两组在年龄（p = 0.77）、性别（p = 0.075）、体重指数（p = 0.22）、住院时间（p = 0.86）、手术侧别（p = 0.51）、美国麻醉医师协会（ASA）评分（p = 0.52）、凯尔格伦·劳伦斯内侧间室骨关节炎评分（p = 0.33）和凯尔格伦·劳伦斯外侧间室骨关节炎评分（p = 0.49）方面无统计学差异。膝关节损伤与骨关节炎疗效评分（KOOS JR）显示，支持对照组（未进行髌骨表面置换）存在统计学显著差异（p = 0.045）。在库亚拉评分（p = 0.98）和牛津膝关节评分（0.89）中未观察到这种差异。
即使在更新的全膝关节设计中，进行髌骨表面置换可能也有作用。在中期随访中，我们未观察到髌骨表面置换（PR）和非髌骨表面置换全膝关节置换术（TKA）在患者报告结局测量（PROMS）方面存在临床意义上的差异。此外，我们未观察到任何影响外科医生决定进行髌骨表面置换的人口统计学因素。有必要进行进一步的高质量研究。
