Diquattro Emanuele, Gregori Pietro, Koutserimpas Christos, Giovanoulis Vasileios, Servien Elvire, Batailler Cécile, Lustig Sébastien
Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, Lyon, France.
SC Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Knee Surg Sports Traumatol Arthrosc. 2025 Jul 7. doi: 10.1002/ksa.12769.
While new philosophies in total knee arthroplasty (TKA) aim to optimize alignment and ligament balancing, restoring the anterior compartment and understanding the consequences of patella resurfacing remain challenging. This study evaluates the functional consequences of anterior compartment restoration, with a specific focus on patella resurfacing when performing robotic-assisted TKA using functional alignment (FA) principles.
This retrospective comparative study included 268 patients affected by an end-stage varus osteoarthritis who underwent robotic TKA according to FA principles. Patients were divided into two main groups based on whether patellar resurfacing procedure was performed (study group) or not (control group). Restoration of the anterior compartment and functional outcomes were evaluated using radiographic assessments, along with the Knee Society Score (KSS Knee and KSS Function), Forgotten Joint Score (FJS) and Kujala Score, all recorded at a minimum follow-up of 2 years.
One hundred thirty-eight cases underwent patellar resurfacing and 130 did not. Patellar tilt and patellar translation were reduced by 74.63% (p < 0.005) and 69.89% (p < 0.005) in the resurfaced group compared to the non-resurfaced group, respectively. The patellar offset values showed no significant differences between the two groups (p = 0.873), although both groups showed a significant reduction in patellar offset in the post-operative compared to the preoperative, 10.31% and 14.29%, respectively, in the resurfaced and non-resurfaced groups (p < 0.05). KSS knee and functional scores were higher in the non-resurfaced group compared to the resurfaced group (p = 0.023 and p = 0.017, respectively). Kujala and FJS scores were similar between the two groups.
Both resurfaced and non-resurfaced approaches improve radiographic outcomes regarding the anterior knee compartment after TKA performed with FA and image-based robotic system, without signs of superiority in clinical outcomes in the resurfaced group. The decision of patella resurfacing can be made on an individualized basis.
Level II.
虽然全膝关节置换术（TKA）的新理念旨在优化对线和韧带平衡，但恢复前侧间室以及理解髌骨表面置换的后果仍然具有挑战性。本研究评估前侧间室恢复的功能后果，特别关注在使用功能对线（FA）原则进行机器人辅助TKA时髌骨表面置换的情况。
这项回顾性比较研究纳入了268例终末期内翻性骨关节炎患者，他们根据FA原则接受了机器人TKA手术。根据是否进行髌骨表面置换手术，将患者分为两个主要组（研究组和对照组）。使用影像学评估以及膝关节协会评分（KSS膝关节和KSS功能评分）、遗忘关节评分（FJS）和库贾拉评分来评估前侧间室的恢复情况和功能结果，所有评分均在至少2年的随访时记录。
138例患者进行了髌骨表面置换，130例未进行。与未进行表面置换的组相比，进行表面置换的组中髌骨倾斜和髌骨平移分别降低了74.63%（p < 0.005）和69.89%（p < 0.005）。两组之间的髌骨偏移值无显著差异（p = 0.873），尽管与术前相比，两组术后的髌骨偏移均显著降低，进行表面置换组和未进行表面置换组分别为10.31%和14.29%（p < 0.05）。未进行表面置换组的KSS膝关节和功能评分高于进行表面置换组（分别为p = 0.023和p = 0.017）。两组之间的库贾拉评分和FJS评分相似。
在使用FA和基于图像的机器人系统进行TKA后，进行表面置换和未进行表面置换的方法在改善膝关节前侧间室的影像学结果方面均有效果，进行表面置换组在临床结果上没有优势迹象。髌骨表面置换的决定可以个体化做出。
二级。
