No significant mid-term differences between TKA with & without patella resurfacing .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2016;4(16):8 Acta Orthop. 2016 Jun;87(3):274-974 patients scheduled for total knee arthroplasty were randomized to undergo the procedure with or without patellar resurfacing. The purpose of this study was to compare short-term functional performance measures, and mid-term patient reported outcome measures of pain, satisfaction, and disease-related quality of life between groups. No significant differences between groups in any short- or mid-term outcome were observed.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
2/4
Randomization
3/4
Outcome Measurements
3/4
Inclusion / Exclusion
2/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
The issue of whether or not routine patellar resurfacing in total knee arthroplasty is necessary has been a considerable point of debate over the last 10 years. There is a wide variation in opinions from surgeons on the appropriateness of patellar resurfacing in TKA procedures. As such, an evidence base of randomized controlled trials is necessary to make recommendations on the practice.
¿Cuál era la pregunta principal de la investigación?
In total knee arthroplasty, is there any significant difference in short-term functional performance, mid-term pain, patient-reported disease-related quality of life and patient satisfaction between patients who received patellar resurfacing and patients who did not receive patellar resurfacing?
- There was no significant difference in VAS pain scores at 6 years between the resurfacing group (11+/-14) and the no resurfacing group (10+/-15) (p=0.7). Results also did not significantly differ between groups at 3 or 12 months (all p>0.05).
- There was no significant difference in the percentage of patients who reported satisfaction with their outcome at 6 years between the resurfacing group (31/33) and the no resurfacing group (34/36) (p=0.5). Results also did not significantly differ between groups at 3 or 12 months (all p>0.05).
- No significant differences were observed in any of the KOOS subscales (Pain, Symptoms, ADL, Sport/Rec, QoL) at any follow-up time-point (all p>0.05); both groups demonstrated significant within-group improvement from preoperative scores for the KOOS subscales.
- Groups did not demonstrate any significant differences in any of the functional performance tests at 3 months: Chair stand test (p=0.9); time taken for 20m walk test (p=0.5); number of steps taken in 20m walk test (p=0.5); number of knee bends performed in 30s (p=0.9).
- Knee extension strength did not significantly differ between groups at 3 months (p=0.8).
- None of the patients in the no-resurfacing group underwent a secondary operation for patellar resurfacing within the first 72 months.
¿Qué es lo que más debo recordar?
In total knee arthroplasty, no significant differences between groups who underwent the procedure with and without patellar resurfacing were observed for short-term functional performance measures, or mid-term patient-reported outcomes of pain, satisfaction, and disease-related quality-of-life.
¿Cómo afectará esto al cuidado de mis pacientes?
The results of this study suggest that short- and mid-term results following total knee arthroplasty did not significantly differ based on whether the patella is resurfaced or not. Given the controversy among practitioners, and varying results from previous randomized controlled trials on the topic, subsequent large-scale trials are necessary to ultimately determine if outcomes of routine total knee arthroplasty are affected by different methods of addressing the patella.
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