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)?
Sì = 1
Incerto = 0,5
Non rilevante = 0
No = 0
La valutazione dei criteri di segnalazione valuta la trasparenza con cui gli autori riportano le caratteristiche metodologiche e sperimentali dello studio all'interno della pubblicazione. La valutazione è suddivisa in cinque categorie che vengono presentate di seguito.
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 di Fragilità è uno strumento che aiuta l'interpretazione dei risultati significativi, fornendo una misura della forza di un risultato. L'Indice di Fragilità rappresenta il numero di eventi consecutivi che devono essere aggiunti a un risultato dicotomico per rendere il risultato non più significativo. Un numero piccolo rappresenta un risultato più debole, mentre un numero grande rappresenta un risultato più forte.
Perché questo studio era necessario ora?
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.
Qual era la domanda di ricerca principale?
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.
Che cosa devo ricordare di più?
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.
Come influenzerà l'assistenza ai miei pazienti?
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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