The controversy of patellar resurfacing in total knee arthroplasty: Ibisne in medio tutissimus?

被引:74
作者
Schindler, Oliver S. [1 ]
机构
[1] St Marys Hosp, Bristol Arthrit & Sports Injury Clin, Bristol BS8 1JU, Avon, England
关键词
Patella; Patellar resurfacing; Total knee arthroplasty; Anterior knee pain; Femoral component design; National joint register; FEMORAL COMPONENT DESIGN; PATELLOFEMORAL JOINT; FOLLOW-UP; RANDOMIZED-TRIAL; RHEUMATOID-ARTHRITIS; UNRESURFACED PATELLA; PATIENT SATISFACTION; CONTACT PRESSURES; BASIC KINEMATICS; CLINICAL-TRIAL;
D O I
10.1007/s00167-012-1985-7
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Early arthroplasty designs were associated with a high level of anterior knee pain as they failed to cater for the patello-femoral joint. Patellar resurfacing was heralded as the saviour safeguarding patient satisfaction and success but opinion on its necessity has since deeply divided the scientific community and has become synonymous to topics of religion or politics. Opponents of resurfacing contend that the native patella provides better patellar tracking, improved clinical function, and avoids implant-related complications, whilst proponents argue that patients have less pain, are overall more satisfied, and avert the need for secondary resurfacing. The question remains whether complications associated with patellar resurfacing including those arising from future component revision outweigh the somewhat increased incidence of anterior knee pain recorded in unresurfaced patients. The current scientific literature, which is often affected by methodological limitations and observer bias, remains confusing as it provides evidence in support of both sides of the argument, whilst blinded satisfaction studies comparing resurfaced and non-resurfaced knees generally reveal equivalent results. Even national arthroplasty register data show wide variations in the proportion of patellar resurfacing between countries that cannot be explained by cultural differences alone. Advocates who always resurface or never resurface indiscriminately expose the patella to a random choice. Selective resurfacing offers a compromise by providing a decision algorithm based on a propensity for improved clinical success, whilst avoiding potential complications associated with unnecessary resurfacing. Evidence regarding the validity of selection criteria, however, is missing, and the decision when to resurface is often based on intuitive reasoning. Our lack of understanding why, irrespective of pre-operative symptoms and patellar resurfacing, some patients may suffer pain following TKA and others may not have so far stifled our efforts to make the strategy of selective resurfacing succeed. We should hence devote our efforts in defining predictive criteria and indicators that will enable us to reliably identify those individuals who might benefit from a resurfacing procedure. Level of evidence V.
引用
收藏
页码:1227 / 1244
页数:18
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