抄録
Objective: We performed total knee arthroplasty (TKA) without patella resurfacing in patients with osteoarthritis of the knee. This study aimed to evaluate problems related to the patellofemoral (PF) joint postoperatively.
Methods: A total of 397 patients (347 affected knees) who had undergone Low Contact Stress mobile bearing knee arthroplasty (Depuy, Warsaw, Ind) six months or more before the study, were enrolled. Subjects included 46 males (36 affected knees) and 351 females (311 affected knees) respectively, with a mean age of 77.7±6.1 years (range, 59-94 years). The mean follow-up period was 72.3±2.4 months (range, 6-129 months). Clinical evaluation employed the Japanese Orthopaedic Association (JOA) scoring system for osteoarthritis of knees. We defined complications as including PF pain, crepitation, patellar clunk syndrome, spin-out, and reoperation. We also performed plain radiographic measurements.
Operations were performed by one surgeon, using the mid-vastus approach with cementless fixation. During the operation, the osteophyte around the patella was resected, and the osteophyte on the articular surface was shaped using a bone saw. Statistical analysis was performed using the Mann-Whitney's U test and a significance level of p<0.05 was adopted.
Results: The average JOA score improved significantly from 46.2±10.4 preoperatively to 82.6±6.1 postoperatively (P = 0.0002).
Postoperative PF pain was found in 37 patients (37 affected knees) at final evaluation. However, in these patients the pain was less severe than it had been preoperatively. Postoperative radiological evaluation was favorable in the majority of cases.
Conclusion: Clinical and radiological evaluation of patella non-resurfacing of mobile bearing total knee arthroplasty was generally favorable. Treatment of the patella in total knee arthroplasty remains controversial. We suggest that treatment of the patella must be determined on the basis of the shape of the sulcus on the femoral component.
