The predictive factors of secondary patellar resurfacing in computer-assisted total knee arthroplasty. A prospective cohort study.

Details

Serval ID
serval:BIB_6D9EAAC211F5
Type
Article: article from journal or magazin.
Collection
Publications
Title
The predictive factors of secondary patellar resurfacing in computer-assisted total knee arthroplasty. A prospective cohort study.
Journal
International orthopaedics
Author(s)
Franck F., Ouanezar H., Jacquel A., Pibarot V., Wegrzyn J.
ISSN
1432-5195 (Electronic)
ISSN-L
0341-2695
Publication state
Published
Issued date
05/2018
Peer-reviewed
Oui
Volume
42
Number
5
Pages
1051-1060
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
The decision to resurface the patella during total knee arthroplasty (TKA) remains controversial. This prospective cohort study aimed to evaluate the outcome and survivorship of the native patella in computer-assisted TKA (CAS TKA) implanted for primary knee osteoarthritis, and to determine the predictive factors of secondary patellar resurfacing (SPR).
A prospective cohort of 273 cementless ultra-congruent mobile-bearing CAS TKA implanted without patellar resurfacing was included in our total joint registry. Patients were evaluated with the International Knee Society (IKS) and Hospital for Special Surgery Patellar (HSSP) scores. Radiographic evaluation was focused on the patellofemoral (PF) compartment to assess: the patellar dysplasia (Wiberg classification), PF osteoarthritis (Iwano classification), femoral trochlear dysplasia (femoral sulcus angle), patellar maltracking (patellar tilt and lateralization), and patella height (Blackburne-Peel ratio).
At a six-year median follow-up, the CAS TKA survivorship using SPR as end-point was 95% (range, 91-99%). The IKS and HSSP improved significantly after SPR (p = 0.001 and 0.004, respectively). No significant difference in the IKS and HSSP was detected between TKA with native patella and SPR-TKA at latest follow-up. Importantly, four pre-operative radiographic PF parameters were significantly associated with SPR: higher stages of patellar dysplasia and PF osteoarthritis, and higher sulcus angle and patellar lateralization (hazard ratios = 5.1 to 11.6, p = 0.009 to 0.04).
When preserving the native patella, surgeons should be aware of pre-operative PF radiographic parameters that could influence the outcome and survivorship of CAS TKA leading to SPR. Particularly, evidence of PF dysplasia, osteoarthritis and maltracking should be determined pre-operatively to resurface the patella at the time of TKA.
Therapeutic Level II (prospective cohort study).
Keywords
Aged, Aged, 80 and over, Arthroplasty, Replacement, Knee/adverse effects, Arthroplasty, Replacement, Knee/methods, Cohort Studies, Female, Humans, Knee Joint/surgery, Male, Middle Aged, Osteoarthritis, Knee/surgery, Patella/surgery, Prospective Studies, Registries, Surgery, Computer-Assisted/adverse effects, Surgery, Computer-Assisted/methods, Survival Analysis, Survivorship, Treatment Outcome, Computer-assisted surgery, Predictive factors, Secondary patellar resurfacing, Total knee arthroplasty
Pubmed
Web of science
Create date
17/01/2020 7:52
Last modification date
18/01/2020 6:26
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