The John Insall Award Control-matched Evaluation of Painful Patellar Crepitus After Total Knee Arthroplasty
The John Insall Award Control-matched Evaluation of Painful Patellar Crepitus After Total Knee Arthroplasty
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DOI：
10.1007/s11999-010-1485-3
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发表时间：
2011-01-01
影响因子：
4.2
通讯作者：
Sharma, Adrija
中科院分区：
文献类型：
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作者：
Dennis, Douglas A.;Kim, Raymond H.;Sharma, Adrija
背景 据报道，接受十字形替代全膝关节置换术 (TKA) 的受试者中，高达 14% 的受试者出现髌骨捻发音 (PC)。已经提出了许多 PC 的病因。问题/目的我们确定了术后疼痛性 PC 的典型发生时间，并将接受初次 TKA 的患者进行了比较，这些患者出现了需要后续手术的疼痛性 PC，与没有这种并发症的对照组进行了比较，以确定与该并发症相关的临床、放射学和手术变量。方法从两个机构的数据库（超过 4000 个 TKA）中，我们确定了 2002 年至 2008 年期间因疼痛性 PC 需要手术的 60 名患者。然后与确定的对照组（由 60 名没有 PC 的 TKA 受试者组成）进行比较，这些受试者的年龄、性别和体重指数等关键变量相匹配，以确定与 PC 发生相关的临床、放射学和手术因素。 结果 出现 PC 的平均时间为 10.9 个月。 PC 的发生率与既往膝关节手术次数增多、髌骨假体尺寸减小、髌骨复合厚度减小、术前和术后髌腱长度缩短、股骨后髁偏移增加、使用较小的股骨假体和较厚的胫骨聚乙烯插入物以及将股骨假体放置在屈曲姿势相关。股骨后髁偏移量的增加都可能增加股四头肌腱对髁间盒上部的接触力，从而增加股骨假体髁间区域内纤维滑膜增殖和卡压的风险。基于这些发现，作者建议尽可能使用较大的髌骨部件，避免髌骨切除或增加股骨后髁偏移，并在术前建议曾接受过膝关节手术或髌腱长度缩短的患者术后发生髌骨捻发音的风险增加。
Background Patellar crepitus (PC) is reported in up to 14% of subjects implanted with cruciate-substituting total knee arthroplasty (TKA). Numerous etiologies of PC have been proposed.Questions/purposes We determined when painful PC typically occurs postoperatively and compared patients undergoing primary TKA who developed painful PC requiring subsequent surgery with a matched group without this complication to identify clinical, radiographic, and surgical variables associated with this complication.Methods From the databases of two institutions (greater than 4000 TKAs), we identified 60 patients who required surgery for painful PC from 2002 to 2008. This group was then compared with an identified control group of 60 TKA subjects without PC who were matched for the key variables of age, gender, and body mass index to determine clinical, radiographic, and surgical factors associated with the development of PC.Results The mean time to presentation of PC was 10.9 months. The incidence of PC correlated with a greater number of previous knee surgeries, decreased patellar component size, decreased composite patellar thickness, shorter preoperative and postoperative patellar tendon length, increased posterior femoral condylar offset, use of smaller femoral components and thicker tibial polyethylene inserts, and placement of the femoral component in a flexed posture.Conclusions Many of the factors associated with an increased incidence of postoperative PC such as shortened patellar tendon length, use of smaller patellar components, decreased patellar composite thickness, and increased posterior femoral condylar offset may all increase quadriceps tendon contact forces against the superior aspect of the intercondylar box, increasing the risk of fibrosynovial proliferation and entrapment within the intercondylar region of the femoral component. Based on these findings, the authors recommend use of larger patellar components when possible, avoid oversection of the patella or increasing posterior femoral condylar offset, and advising patients preoperatively who have had previous knee surgery or demonstrate a shortened patellar tendon length of an increased risk of development of postoperative patellar crepitus.