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Objective To compare the total knee arthroplasty with and without patellar resurfacing replacement clinical and radiographic efficacy for future clinical better provide the basis to carry out this operation. Methods A prospective randomized method, the orthopedic hospital in January 2006 to January 2008 period with and without patellar resurfacing row permutation unilateral total knee arthroplasty (Total Knee Arthroplasty, TKA) were studied by inclusion and exclusion criteria received a total of 83 cases of 83 knees, including 40 replacement knee patella group of 40 patients, 11 males and 29 females, mean age 64.6 ± 7.69 years (42 to 80 years); No replacement knee patella group of 43 patients 43 male 13 cases, 30 females, mean age 64.3 ± 7.25 years (41 to 78 years). Resurfacing and replacement is not caught using the posterior cruciate ligament-retaining tibial and femoral component (Gmini II, Link, Germany) bone cement fixation, resurfacing while those three all-polyethylene patellar component fixed with cement column. A clinical observation indicators include: operation time, surgery-related blood loss, intraoperative lateral patellar cartilage damage extent and whether the release and other support band; clinical evaluation criteria include: the KSS knee function assessment criteria, assessment criteria Feller patella, and to assess patient satisfaction of the British Orthopaedic Association standards; 2, radiographic outcomes included: positive and lateral X-ray film and knees 45 degrees patellar axial slices on the tibiofemoral angle, the ratio of patellar ligament and patellar tilt angle. 3, analysis of age, obesity, height, and body mass index on the curative effect after TKA, as well as the possibility of postoperative anterior knee pain predictors. All data groups SPSS 13.0 was used for statistical analysis and comparison, P lt; 0.05 considered statistically significant. Results All patients were followed up for at least two years of full, group and not in substitution patella replacement group 1 case each, respectively, after 18 months and 21 months, in the X-ray film showed greater than 90 degrees of knee flexion bit patellar subluxation, but this two cases no clinical symptoms. Two groups of patients still had no prosthesis loosening, periprosthetic fracture, infection, complications such as patellofemoral disorders, and no one case of any complications due to renovations to accept those. 1 Clinical efficacy: resurfacing group except the timing of surgery than those without replacement group was significantly longer outside (P lt; 0.001), in the surgery-related blood loss, Lateral release and patella cartilage damage and not in terms of the substitution group There was no significant difference (P = 0.25, P = 0.47, P = 0.06). Replacement patella group and no substitution group KSS knee function score was significantly improved compared with preoperative (P lt; 0.001), from an average of 95.37 ± 16.26 minutes (57 to 127 points) and 90.44 ± 17.45 minutes (39 to 125 minutes ) increased to an average of 164.1 ± 17.55 points postoperatively (128 to 195 points) and 162.63 ± 16.39 points (117 to 193 points), the two groups in the KSS knee score, knee function and sub-pain scores were not significantly different (P = 0.69, P = 0.23, P = 0.90). Replacement patella group and no knee replacement group, the average degree from preoperative 85.88 ± 12.75 degrees (60 to 120 degrees) and 82.33 ± 12.17 degrees (55 to 110 degrees) improved to postoperative 96.00 ± 9.00 degrees (80 to 120 degrees ) and 94.88 ± 7.98 degrees (80 to 120 degrees), the average postoperative activity compared no significant difference (P = 0.55). The average postoperative Feller patellar score was significantly improved compared with the preoperative (P lt; 0.05), respectively, by an average of 17.45 ± 4.67 preoperatively points (6-24 points) and 18.53 ± 4.27 minutes (8 to 26 points) improved to an average of surgery after 25.45 ± 3.83 minutes (11 to 30 minutes), and 26.79 ± 3.90 min (7 to 30), the average postoperative patella ability score and down stairs no difference, the statistical values of P = 0.11 and P = 0.67; patella replacement group and the group without replacement rate of anterior knee pain was 40% (16/40 knees) and 34.9% (15/43 knees), the difference was not statistically significant (P = 0.63), satisfaction was 82.5% (33 / 40 cases) and 70% (30/43 cases), the difference was not statistically significant (P = 0.25). 2, radiographic evaluation: the two groups in postoperative tibiofemoral angle, the ratio of the patellar tendon, patellar tilt angle measurements were no differences (P = 0.08, P = 0.16, P = 0.72). 3, the two groups in age, weight, body mass index, height, aspect not found to influence not patellar resurfacing and replacement of the clinical efficacy; preoperative anterior knee pain, chondromalacia patella tilt and extent of the damage has not been proven in both groups etc. postoperative anterior knee pain affected. Conclusions 1. Resurfacing or not, can get the pain and function after TKA significantly improved; 2 preoperative anterior knee pain, patellar cartilage damage extent patellar tilt angle on postoperative anterior knee pain does not affect; 3. False body and the rational design of instruments and standardized surgical procedures, as well as doctors experience is still the key to determine the efficacy of TKA.
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