| Objective:Total knee arthroplasty is one of the most effective and successful operations for the treatment of end-stage or severe knee osteoarthritis(OA).In China most outpatients have suffered from patellofemoral end-stage osteoarthritis for a long time as the difference of medical service among the country.The controversy over routinely resurface the patella,non-resurface the patella,selectively resurface the patella during TKA has persisted despite decades of successful joint replacement procedures.Lots of the relatively studies only focused on the KSS after TKA,never had been studied the direct relationship between the knee function and patellar resurfacing after TKA.The indexes of 2 groups were from the patients' complain in the clinic,were firstly highlighted in the study,which is different from the regular trials of patella resurfacing.The purpose of the present study is to investigate the direct relationship with self-control RCT(Randomized controlled trial).Materials and Methods:In our department,between March 2013 and August 2015,30 patients(60 knees)with osteoarthritis who met the inclusion criteria were recruited in the study.Of 30 cases,24 were male and 6 were female with an average age of 57.2 years(range,37-65 years).The body mass index(BMI)ranged from 19.5 to 40.3 kg/m2(mean,28.2 kg/m2).According to Kellgren-Lawrence grading,there were 8 cases at grand ? and 22 cases at grand ?.All patients underwent primary bilateral TKA.The patellar resurfacing was done at the unilateral knee randomly(resurfacing side);the opposite treatment was done at the other side(non-resurfacing side).The procedure of resurfacing patellar should be very careful.The indexes of 2 groups were changed into four grades question:very hard,hard,little hard,no hard.All questions were recorded and compared.The indexes include operation time,intraoperative blood loss,knee society score(KSS),“Forgotten Joint',scale(FJS),anterior knee pain and its sites,anterior patellar spirant,knee constraint feeling,anterior patellar clunk,muscle power of knee extension,and ability of up and down stairs,weight-bearing flexion,squatting down,cross-legged,kneeling,knee extension,and patient satisfaction.Radiographic examination vas used to analyze the prosthesis position.Results:All patients were followed up 2-4 years(mean,2.6 years).Radiographic examination showed no prosthesis loosing occurred.The operation time were(126±14)minutes and(112±11)minutes in resurfacing side and non-resurfacing side,respectively,showing significant difference between two sides(P=0.030);and there was no significant difference in intraoperative blood loss(P=0.800).There was no significant difference(P>0.05)between two sides in KSS clinical and functional scores at pre-operation and 6 weeks,6 months,and 2 years after operation;in visual analogue scale(VAS)score of anterior knee pain at pre-operation and 6 weeks after operation;in incidences of anterior patellar spirant,knee constraint feeling,anterior patellar clunk,and muscle power of knee extension at 6 weeks,6 months,and 2 years after operation;in incidences of disability of up and down stairs,weight-bearing flexion,squatting down,cross-legged,kneeling,and knee extension at 6 weeks,6 months,and 2 years after operation;in ratio of FJS score at 2 years after operation.The VAS scores at 6 months and 2 years after operation in resurfacing group were significantly lower than those in non-resurfacing group(P=0.046;P=0.028).Patient satisfaction of resurfacing side was superior to the non-resurfacing side at 6 weeks after operation(P=0.039).Besides,Site 5,7,8 were the main part of anterior pain preoperatively,and site 5 was the most frequently part of anterior pain postoperatively as the regular trials in these years.At the site 5,7,8 the pain of patella resurfaced is more relieved as time going on than that of patella non-resurfaced.The patella non?resurfaced group showed only the pain relieved at the site 8.The sites of anterior knee pain were less postoperatively than preoperatively.The number of anterior sites of resurfacing group were down to 4 from 7,the non-resurfacing group is still 7.Conclusion:In the total knee arthroplasty,the side with and without patellar resurfacing both suffered some kinds of uncomfortableness,but the side with PR never had other more complications than the side without PR.Patient satisfaction of resurfacing side was superior to the non-resurfacing side at 6 weeks after operation.The VAS scores at 6 months and 2 years after operation in resurfacing group were significantly lower than those in non-resurfacing group.Site 10 showed new pain in both groups postoperatively.The number of anterior sites of resurfacing group were down to 4 from 7,the non-resurfacing group is still 7.Compared with the other series reporting on bilateral TKA,anterior knee pain site was firstly highlighted in the study.And thus we could generalize our results to improve operative procedure and enhance the self-feeling of patients accurately before the incidence of anterior pain. |
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