ARTHROPLASTY
A randomized controlled trial comparing patellar retention versus patellar resurfacing in primary total knee arthroplasty: 5–10 year follow-up
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(10):4 BMC Res Notes. 2012 Jun 7;5:273. doi: 10.1186/1756-0500-5-27338 total knee arthroplasty patients with non-inflammatory arthritis were randomized to either patellar resurfacing or to patellar retention to compare functional and revision outcomes over a 10 year time period. Despite the diminishing health, in a ten year follow-up, the results showed that knee pain, stiffness, and function improved in both groups, with no significant differences between them. Both treatment methods had similar revision rates, all occurring within the first 5-years.
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)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
4/4
Randomização
2/4
Medidas de resultado
3/4
Inclusão/Exclusão
4/4
Descrição do tratamento
3/4
Estatística
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
With the high success rate of total knee arthroplasties (TKA), surgeons still debate the need for patellar resurfacing. Previous studies have shown mixed results and did not investigate the long term effects of this resurfacing procedure. Therefore, the study sought to determine whether there is an existing difference in knee scores and re-operative rates between patellar resurfacing and patellar retention techniques in TKA.
主な研究課題は何ですか？
How do knee stiffness, pain, function, and re-operation rates compare between patellar retention and resurfacing, after a 10-year follow-up of TKA?
重要な知見は？
- At both 5 and 10 year follow ups, the groups improved in knee function despite increasing age. No significant differences were noted between the groups (p>0.01).
- No significant difference in stiffness (WOMAC) was found between groups at 5 year and 10 year follow ups (p>0.01).
- Both groups significantly improved in pain scores from baseline at 5 and 10 year follow-up, with no significant differences between the groups (p>0.18).
- All revisions occurred within 5 years, and both groups had similar revision rates (p=0.31). (4 in total)
- 10% of the patients who retained the patella had to undergo re-operation for persistent anterior knee pain.
- Both groups deteriorated in overall health status within 10 years according to RAND-36 General Health Scores.
最も覚えておくべきことは？
The results of a ten year follow-up demonstrated that no significant differences existed between patients who received patellar resurfacing versus patients who did not undergo patellar resurfacing in terms of knee pain, stiffness, and function. However, 10% of the patients who retained the patella had to undergo re-operation for persistent anterior knee pain. Unfotunately, this study was under powered to detect differences in re-operation rate.
それが私の患者ケアにどのように影響するか？
Although there were no major significant differences found between patellar resurfacing group and the patellar retention group, there was a slight difference in re-operation rates for the retaining group. Further studies with objective outcomes, such as radiographic and surgical analyses, as well as larger population sizes are needed to draw clear conclusions.
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