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Resurfacing in a Posterior-Stabilized Total Knee Arthroplasty Reduces Patellar Crepitus Complication: A Randomized, Controlled Trial.
J Arthroplasty 2019; 34(9):1969-1974JA

Abstract

BACKGROUND

Patellar crepitus (PC) is a common complication after total knee arthroplasty (TKA) using a posterior-stabilized (PS) prosthesis. While numerous factors have been associated with PC development after PS-TKA, patellar resurfacing (PR) which directly impacts the patellofemoral joint kinematics has been underinvestigated. A prospective, randomized, controlled trial was conducted to (1) compare the PC incidence in PR and non-PR PS-TKA, (2) determine the time of PC presentation in PS-TKA, (3) identify radiographic parameters associated with PC, and (4) compare clinical outcomes of patients with and without PR.

METHODS

A total of 84 patients who underwent unilateral TKA using the Legion PS Total Knee System were randomized into PR group or non-PR group. PC incidence, time of PC presentation, radiographic parameters associated with PC development, and clinical outcomes were evaluated at 3 months, 6 months, 9 months, and 1 year postoperatively.

RESULTS

PC occurred significantly more in the non-PR group (23.1% vs 7.3%, P = .048). Time of PC presentation in both groups was not different. Anterior knee pain was found in 16.7% of crepitus patients, and none required any surgical procedure. The non-PR knees had significant decreases in patellar shift index, patellar displacement, Insall-Salvati ratio, and patellar component height and increase in change in posterior femoral offset. Oxford and patellar scores were significantly better in the PR group at 9 months and 1 year.

CONCLUSION

Given higher PC incidence and several worse clinical outcomes in the non-PR, we recommend resurfacing during PS-TKA with this knee system to avoid PC development.

Authors+Show Affiliations

Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand.Center of Data Mining and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Salaya, Nakornpathom, Thailand.Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31126775

Citation

Thiengwittayaporn, Satit, et al. "Resurfacing in a Posterior-Stabilized Total Knee Arthroplasty Reduces Patellar Crepitus Complication: a Randomized, Controlled Trial." The Journal of Arthroplasty, vol. 34, no. 9, 2019, pp. 1969-1974.
Thiengwittayaporn S, Srungboonmee K, Chiamtrakool B. Resurfacing in a Posterior-Stabilized Total Knee Arthroplasty Reduces Patellar Crepitus Complication: A Randomized, Controlled Trial. J Arthroplasty. 2019;34(9):1969-1974.
Thiengwittayaporn, S., Srungboonmee, K., & Chiamtrakool, B. (2019). Resurfacing in a Posterior-Stabilized Total Knee Arthroplasty Reduces Patellar Crepitus Complication: A Randomized, Controlled Trial. The Journal of Arthroplasty, 34(9), pp. 1969-1974. doi:10.1016/j.arth.2019.04.050.
Thiengwittayaporn S, Srungboonmee K, Chiamtrakool B. Resurfacing in a Posterior-Stabilized Total Knee Arthroplasty Reduces Patellar Crepitus Complication: a Randomized, Controlled Trial. J Arthroplasty. 2019;34(9):1969-1974. PubMed PMID: 31126775.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Resurfacing in a Posterior-Stabilized Total Knee Arthroplasty Reduces Patellar Crepitus Complication: A Randomized, Controlled Trial. AU - Thiengwittayaporn,Satit, AU - Srungboonmee,Kakanand, AU - Chiamtrakool,Bhakawat, Y1 - 2019/05/02/ PY - 2019/02/18/received PY - 2019/04/19/revised PY - 2019/04/24/accepted PY - 2019/5/28/pubmed PY - 2019/5/28/medline PY - 2019/5/26/entrez KW - patellar crepitus KW - patellar non-resurfacing KW - patellar resurfacing KW - posterior-stabilized KW - total knee arthroplasty SP - 1969 EP - 1974 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 34 IS - 9 N2 - BACKGROUND: Patellar crepitus (PC) is a common complication after total knee arthroplasty (TKA) using a posterior-stabilized (PS) prosthesis. While numerous factors have been associated with PC development after PS-TKA, patellar resurfacing (PR) which directly impacts the patellofemoral joint kinematics has been underinvestigated. A prospective, randomized, controlled trial was conducted to (1) compare the PC incidence in PR and non-PR PS-TKA, (2) determine the time of PC presentation in PS-TKA, (3) identify radiographic parameters associated with PC, and (4) compare clinical outcomes of patients with and without PR. METHODS: A total of 84 patients who underwent unilateral TKA using the Legion PS Total Knee System were randomized into PR group or non-PR group. PC incidence, time of PC presentation, radiographic parameters associated with PC development, and clinical outcomes were evaluated at 3 months, 6 months, 9 months, and 1 year postoperatively. RESULTS: PC occurred significantly more in the non-PR group (23.1% vs 7.3%, P = .048). Time of PC presentation in both groups was not different. Anterior knee pain was found in 16.7% of crepitus patients, and none required any surgical procedure. The non-PR knees had significant decreases in patellar shift index, patellar displacement, Insall-Salvati ratio, and patellar component height and increase in change in posterior femoral offset. Oxford and patellar scores were significantly better in the PR group at 9 months and 1 year. CONCLUSION: Given higher PC incidence and several worse clinical outcomes in the non-PR, we recommend resurfacing during PS-TKA with this knee system to avoid PC development. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/31126775/Resurfacing_in_a_Posterior-Stabilized_Total_Knee_Arthroplasty_Reduces_Patellar_Crepitus_Complication:_A_Randomized,_Controlled_Trial L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(19)30418-8 DB - PRIME DP - Unbound Medicine ER -