Anterior knee pain in rheumatoid patients after total knee replacement. Possible selection criteria for patellar resurfacing

Considering its cost saving, the all-polyethylene tibial component is of potential interest in developing countries like China. But to our knowledge, a survivorship comparison of all-polyethylene and metal-backed tibial components in posterior cruciate ligament-substituting total knee arthroplasty (PS-TKA) has not been studied in China previously. Using survivorship analysis, we have studied the midterm outcome of 34 cemented PS-TKA using an allpolyethylene tibial component and of 34 cemented PS-TKA using a metal-backed tibial component which has an identical articular surface with all-polyethylene tibial components. All operations were performed by the same group of surgeons; 58 patients underwent a unilateral operation and five patients a bilateral operation. These patients had a mean follow-up of 5.9 years (range: 5-7 years); three patients were lost to followup and one was revised for infection. No significant difference between the two groups was reported regarding HSS scores, ROM, clinical and radiographic parameters measured and survival rates. Although the Asian lifestyle includes more squatting and bending of the knee, the results of this series of TKA using all-polyethylene tibial components in Chinese people are comparable to the satisfactory results of other reported all-polyethylene series whose patients are mainly Western people. Considering its cost saving and excellent clinical result, the all-polyethylene tibial component is of potential interest in developing countries.Résumé Les plateaux tibiaux tout polyéthylène APTC permettent une économie financière aux niveaux des implants et ont un intérêt potentiel pour la Chine. En utilisant une analyse avec courbe de survie, nous avons réalisé un suivi moyen de 5,9 ans (5 à 7 ans) pour 34 prothèses postéro stabilisées cimentées PS-TKA en utilisant un plateau tout polyéthylène APTC. Et 34 prothèses avec un métal back MBTC avec la même surface de glissement que l'APTC. Il n'y a pas de différence significative entre les deux groupes si l'on considère le score HSS, la mobilité et la clinique ainsi que les paramètres radiographiques et les courbes de survie. Les courbes de survie à 5,9 ans sont de 93,55% pour le groupe APTC et de 93,75% pour le groupe MBTC. Cependant, le mode de vie asiatique nécessitant des flexions antérieures et une flexion importante des genoux ont un résultat identique chez les chinois (en utilisant une APTC) avec des résultats comparables et tout à fait satisfaisants comparées aux autres séries de plateaux tout PE des populations occidentales. Si l'on considère l'économie réalisée et les excellents résultats cliniques des prothèses APTC avec un composant tout polyéthylène, ceux-ci sont intéressants pour ces pays en voie de développement.

Section: Discussionmentioning

confidence: 99%

Survivorship comparison of all-polyethylene and metal-backed tibial components in cruciate-substituting total knee arthroplasty—Chinese experience

Shen

Yang

Zhou

et al. 2008

“…That it is controversial to resurface the patella in total knee arthroplasty (TKA) remains as a topic in the literature because of the higher incidence of anterior knee pain after TKA without patellar resurfacing [1,2], which was reported to be between 5 and 47% of patients [3][4][5][6][7], and the general idea that the aetiology of anterior knee pain is related to the patellofemoral joint. Some authors recommend routinely resurfacing the patella [7][8][9][10][11], while others have reported no evidence to support routine patellar resurfacing.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of patellar resurfacing in total knee arthroplasty

Chen

et al. 2010

Controversies existing over resurfacing the patella in total knee arthroplasty remain in the literature. The purpose of this review was to evaluate the effectiveness of resurfacing versus nonresurfacing the patella in total knee arthroplasty. We searched the Cochrane Library, MEDLINE and EMBASE for published randomised clinical trials relevant to patellar resurfacing. The relative risk of reoperation was significantly lower for the patellar resurfacing group than for the nonresurfacing group (relative risk 0.57, 95% confidence interval 0.38-0.84, P=0.004). The overall incidence of postoperative anterior knee pain of the 1,421 knees included was 12.9% in the patellar resurfacing group and 24.1% in the nonresurfacing group. The existing evidence indicates that patellar resurfacing can reduce the risk of reoperation with no improvement in postoperative knee function or patient satisfaction over total knee arthroplasty without patellar resurfacing. Whether it can decrease the incidence of anterior knee pain remains uncertain.

“…Some authors feel that routine use of patellar resurfacing is unnecessary [1,8,18];however, they stress that it is important to maintain patellar height by appropriate positioning of the tibial and femoral components and the necessary soft tissue release in order to obtain stability of the patellar component. The reason given is a significant complication rate associated with patella resurfacing that is not encountered in the group without resurfacing [21].…”

Section: Discussionmentioning

confidence: 99%

“…A relative indication for patel- lar retention includes a young patient with good compliance and high demands. Soft tissue balancing is important, as patellar resurfacing alone will not prevent the occurrence of anterior knee pain [5,8].…”

Section: Discussionmentioning

confidence: 99%

Should the patella be replaced in total knee replacement?

Badhe

Dewnany

Livesley

2001

In 170 total knee arthroplasties for osteoarthritis 71 did not receive a patellar replacement (group A), while 99 knees had a cemented polyethylene patella (group B). The mean follow-up time was 36 months (30-50 months). In group A 10 patients underwent second-stage patellar resurfacing and in group B 2 knees underwent revision of the patellar component. Radiologically the average patellar congruency was similar. In both groups there were 21 non-congruent knees. In group A 8 were symptomatic and had low scores compared to 2 in group B (P<0.05). The mean HSS score and patellar score were higher in group B than in group A (P<0.05). Résumé