No difference between patellar retention and resurfacing in TKA at 10 years .
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)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
4/4
Randomization
2/4
Outcome Measurements
3/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
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.
Qual era a principal questão de investigação?
How do knee stiffness, pain, function, and re-operation rates compare between patellar retention and resurfacing, after a 10-year follow-up of TKA?
- 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.
De que é que me devo lembrar mais?
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.
Como é que isto afectará o tratamento dos meus doentes?
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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