Scheurer, P. (Philip) (2012) Klinische en radiologische resultaten na secundaire patellaprothese plaatsing bij totale knieartroplastiek; een retrospectieve studie. thesis, Medicine.
Full text available on request.Abstract
Introduction: A total knee arthroplasty (TKA), in which both the medial and the lateral compartment of the knee is replaced by a prosthesis, is one of the most performed orthopedic surgical procedures. Whether or not to resurface the patella during TKA has been a topic of discussion. There is a higher risk of developing, or persisting of anterior knee pain (AKP) when the patella remains unresurfaced during TKA. The emergence or persistence of AKP after TKA is seen as the main indication for secondary patellar resurfacing (SPR). Little research has been done into the clinical and radiographic results of SPR. Objective: The primary aim of this study is to evaluate the outcome (clinical and radiological) of SPR after TKA in the long term. Secondary aim is to examine the value of a preoperative bone scan in the outcome of SPP. Another aim is to identify factors that differ between the success group and the failure group. The success group is defined as all patients who are satisfied with the outcome of SPR and would have surgery again. The failure group is defined as patients who would not have surgery again because of insufficient improvement. Methods: In this retrospective study a total of 60 patients (54 women (90%) and 6 men (10%)) with a mean age of 70 years at the time of SPR are included. Excluded patients were also used for the analysis of complications (N=76). Physical function and quality of life (QoL) are evaluated using the KOOS, the patellofemoral problems using the Baldini score. Several questions are asked to rate the satisfaction of the patients who underwent SPR. The visual analogue scale (VAS) for AKP pre- and postoperatively is checked and documented. The X-ray images are reviewed by a radiologist for the presence of patellar tilt, subluxation of the patella and any other abnormalities. In 52 of the 60 patients a bone scan was made prior to SPP. The bone scans are reassessed by a nuclear physician. The success group and failure group are compared in order to identify differences in patient factors which may affect the outcome following SPR. Results: With a median follow-up of 34 (6-76) months, 43 patients (72%) were satisfied with the results of the SPR, 10 patients (17%) neutral and 7 patients (11%) dissatisfied. Complications occurred in 6 patients (8%) and revision was necessary in 3 patients (4%). The mean KOOS for pain, symptoms, ADL and QoL and Baldini score of SPP patients were respectively: 65, 69, 62, 44 and 71. The VAS for AKP decreased an average of 3,7 points after SPR. Patellar tilt and subluxation was seen in, respectively in 19 (32%) and 2 knees (3%) on the Merchant view. No other radiological abnormalities were found. Patellar tilt was significantly more often seen in the failed group. Patients with a ‘hot’ bone scan are not more often satisfied with the outcome of SPR than patients with a ‘cold’ bone scan. Patients in the success group had a significantly longer interval between TKA and SPR and a significantly higher preoperative VAS than the failed group. Conclusion: In a majority of the patients with AKP after TKA, SPR resulted in satisfieds patients and decrease of symptoms. In this study, complications were present in 8% and reoperation was required in 4% of the patients. Physical function and quality of life of patients after SPP is decreased and they experience patellofemoral problems. Patellar tilt is seen in 19 knees and was significantly more often seen in the failure group. Patients with a ‘hot’ bone scan preoperatively have no better outcome than patients witch a ‘cold’ bone scan. Patients who had a longer interval between TKA and SPR and had a higher rate of AKP seem to have a better result following SPR.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Begeleider: and Raaij, Dr. J.J.A.M. van |
| Supervisor name: | Extern begeleider: and Reininga, Dr. I.H.F and Afdeling orthopedie Martiniziekenhuis Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:07 |
| Last Modified: | 25 Jun 2020 11:07 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2703 |
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