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)?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
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
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
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.
Quelle était la principale question de recherche ?
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.
De quoi dois-je me souvenir en priorité ?
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.
Comment cela affectera-t-il les soins prodigués à mes patients ?
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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