Systematic Review Of Patellar Replacement In Total Knee Arthroplasty

Objective To evaluate the efficacy of patellar replacement of total knee replacement (Total knee arthroplasty, TKA) systematically, to provide references for further clinical research and medical practice.Materials and methods:In accordance with strict inclusion and exclusion criteria and the pre-developed search strategy, the following databases and journals were searched for relavant articles:the databases of the Cochrane UpperGastro-intestinal and Pancreatic Group specialised register, Cochrane Central Register of Controlled Trials(Phase 1 of 2011), MEDLINE(1950～2011.1), PubMed (1950-2011.1), EMBASE (1980～2011.1), CBM, CNKI and VIP (1989～2011.1). Meta analysis uses the Revman 5.0.25 software provided by Cochrane collaboration. The heterogeneity of pilot test among researches is used by the chi-square test. The fixed-effect model analysis was adopted in case of absence of heterogeneity(p>0.05), otherwise the sources of heterogeneity were analyzed,and random effect model was adopted in accordance with the actual situation, even use sub-group analysis or abandon Meta-analysis, instead of descriptive analysis only. If the research data collected is impossible or inappropriate to carry out Meta analysis, descriptive analysis only.Results 1788 knees were included in the 14 published trials,including 886 knees in the resurfaced group and 902 in the nonresurfaced group. The result of meta-analys is indicated that the risk of postoperative anterior knee pain was lower in patellar resurfacing group than in patellar nonresurfacing group between 5 years and 7.5 years, The combined RR was 0.19,95% CI (0.11,0.31);But the difference did not exist within 5 years or after?.5 years.The risk of reoperation had no significant difference in patellar resurfacing group and patellar nonresurfacing group within 5 years.But 5 years later, the risk of reoperation was lower in patellar resurfacing group than in patellar nonresurfacing group.The combined RR was 0.49,95% CI (0.33,0.75); Whether using sub-group analysis or using general analysis, there was no difference in the mean postoperative knee scores WMD for the results of general analysis was 0.26,95% CI (-1.39,1.90); Whether using sub-group analysis or using general analysis,there was no difference in patient satisfaction too.The combined RR for results of general analysis was 0.26,95% CI(-1.39,1.90).Conclusion The efficacy of resurfacing the patella in total knee arthroplasty is better than nonresurfacing the patella in total knee arthroplasty in the mass.