Influence of patellofemoral joint degeneration on clinical outcomes after medial unicompartmental knee arthroplasty  

作　　者：Limin Wu Quan Chen Haibo Si Yuangang Wu Yi Zeng Mingyang Li Yuan Liu Bin Shen 

机构地区：[1]Department of Orthopedics,Orthopedic Research Institute,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China

出　　处：《Chinese Medical Journal》2023年第13期1539-1550,共12页中华医学杂志（英文版）

基　　金：National Natural Science Foundation of China(81802210 and 81672219);Key Project of Sichuan Science&Technology Department(2018SZ0223 and 2018SZ0250);National Clinical Research Center for Geriatrics,West China Hospital,Sichuan University(Z20191008 and Z2018B20)

摘　　要：Background:Patellofemoral joint(PFJ)degeneration has traditionally been regarded as a contraindication to unicompartmental knee arthroplasty(UKA).More recently,some researchers have proposed that PFJ degeneration can be ignored in medial UKA,and others have proposed that this change should be reviewed in PFJ degenerative facets and severity.This study aimed to systematically evaluate the effect of PFJ degeneration on patient-reported outcome measures(PROMs)and revision rates after medial UKA.Methods:Electronic databases(PubMed,Embase,Web of Science,etc.)were searched for studies assessing the influence of PFJ degeneration on medial UKA.A random-effects meta-analysis was conducted for the Oxford knee score(OKS),Knee society score(KSS),and revision rates and stratified by PFJ degenerative facets(medial/lateral/trochlear/unspecified),severe PFJ degeneration(bone exposed),and bearing type(mobile/fixed).Heterogeneity was assessed by the Cochran Q test statistic and chi-squared tests with the I-squared statistic.Results:A total of 34 articles with 7007 knees(2267 with PFJ degeneration)were included(5762 mobile-bearing and 1145 fixed-bearing and 100 unspecified).Slight to moderate degenerative changes in the medial and trochlear facets did not decrease the OKS and KSS,and only lateral facets significantly decreased the OKS(mean difference[MD]=-2.18,P<0.01)and KSS(MD=-2.61,P<0.01).The severity degree of PFJ degeneration had no additional adverse effect on the OKS,KSS,or revision rates.For mobile-bearing UKA,only lateral PFJ degeneration significantly decreased the OKS(MD=-2.21,P<0.01)and KSS(MD=-2.44,P<0.01).For fixed-bearing UKA,no correlation was found between PROMs/revision rates and PFJ degeneration.Conclusion:For medial mobile-bearing UKA,slight to moderate degenerative changes in the PFJ,except lateral facet,did not compromise PROMs or revision rates.For medial fixed-bearing UKA,although it might not be conclusive enough,PROMs or revision rates were not adversely affected by PFJ degeneration(regardless of the facet

关 键 词：Unicompartmental knee arthroplasty Fixed-bearing MOBILE-BEARING Patellofemoral degeneration Clinical outcomes 

分 类 号：R687.4[医药卫生—骨科学]