| Objective: To compare prospectively the clinical and radiographic outcomes of total knee arthroplasty with and without patellar replacement, and to provide the reference for clinical orthopedist in total knee arthroplasty whether or not patella replacement.Methods: From January 2006 to January 2008, we performed a prospective randomized study for osteoarthritis by unilateral TKA with and without patella replacement in the first hospital affiliated to the Suzhou University. According to inclusion and exclusion criteria, Eighty-three patients (83 knees) meet criteria, forty knees underwent patellar replacement, and Forty-three knees without replacement. All patients performed TKA with cemented posterior cruciate-retaining tibial and femoral components (Gmini II,Link,Germany), all knees that had patellar replacement used a cemented all-polyethylene patellar component with three peg. 1,Clinical Evaluated System:operative time,blood loss,lateral retinacular release and the patellar articular cartilage. The patients were scored using KSS Score for knees,Feller Score for patella and the British Orthopaedic Association patient-satisfaction score. 2,Radiographic Evaluation standard:measured valgus angle,Insall-Salvati ratio and patellar tilt. All datas were analyzed using SPSS 13.0 software, significant statistical difference used P<0.05.Results: All patients were followed up for two years, two patients underwent patellar dislocation in patellar replacement at postoperative 18 months and without patellar replacement at postoperative 21 month. 1,Clinical Evaluated System:Comparing patellar replacement with patellar retention, except for operative time having significant difference(P<0.001), blood loss,lateral retinacular release and articular cartilage were no significant difference in two groups(P=0.25, P=0.47 and P=0.06). Comparing patellar replacement with patellar retention, the postoperative mean KSS score was no significant difference (P=0.67). The preoperative mean KSS score of patients with patellar replacement and patellar retention respectively improved from 95.37±16.26 points (57-127 points) to 164.1±17.55 points (128-195 points) and 90.44±17.45 points (39-125 points) to 162.63±16.39 points (117-193 points) at the most recent follow-up, but postoperative mean KSS score was significant higher than preoperative in two groups (P<0.001), the postoperative mean sub-score for function and pain were no significant difference (P=0.23,P=0.9). The preoperative mean Range Of Motion (ROM) of patients with patellar replacement and without patellar replacement were respectively 85.88±12.75°(60-120°) and 82.33±12.17°(55-110°), the postoperative ROM respectively 96.00±9.00°(80-120°) and 94.88±7.98°(80-120°), comparing patellar replacement with patellar retention, the postoperative mean ROM didn't showed difference (P=0.55). The preoperative mean Feller patellar score of patients with patellar replacement and patellar retention respectively improved from 17.45±4.67 points(6-24 points) to 25.45±3.83 points (11-30 points) and 18.53±4.27 points (8-26 points) to 26.79±3.90 points(7-30 points) at the most recent follow-up, Comparing patellar replacement with patellar retention, the postoperative mean Feller patellar score were no significant difference(P=0.11), but were significant higher than the preoperative in two groups (P<0.05). With the numbers available, we couldn't detected significant difference between the patients of two groups with regard to the ability to climb stairs (P=0.67). Sixteen patients (40 knees; 40%) in the resurfacing group had anterior knee pain (AKP), compared with fifteen patients (43 knees; 34.9%) in the non-resurfacing group. This difference was no significant (p=0.63). Thirty-three patients (40 knees; 72.3%) in the resurfacing group were enthusiastic or satisfied, compared with thirty patients (43 knees; 70%) in the non-resurfacing group, The difference wasn't significant(P=0.25). 2,Radiographic Evaluation:With the numbers available, we could detected no significant difference between the two groups of patients with regard to measured valgus angle,Insall-Salvati ratio and patellar tilt (P=0.08, P=0.16 and P=0.72). 3,With the numbers available, we couldn't detect that age, weight, height and body mass index (BMI) effected the clinical results of the patients with patellar replacement and retention; The preoperative AKP, the patellar articular cartilage and the patellar tilt didn't predicted the results of postoperative Anterior Knee Pain in two groups. Conclusion:1. At the end of two years follow-up, regardless of patellar replacement or retention in TKA,the patients with osteoarthritis would gained the improvement of pain and function, thereby improved patient's life quality and recovered daily groundwork and activity; patients with patellar replacement or retention in TKA didn't found severe complication. 2. Age, weight, height and body mass index (BMI) didn't effected the clinical results of the patients with patellar replacement and retention, and the preoperative anterior knee pain. 3. The preoperative AKP, the patellar articular cartilage and the patellar tilt didn't predict the results of postoperative Anterior Knee Pain. 4. The orthopedist should selected proper prosthesis design and refined surgical technic, as would decrease the incidence rate of complications and improve clinical effect. |
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