gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie
72. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 94. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie und 49. Tagung des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie

22. - 25.10.2008, Berlin

To resurface or not to resurface the patella in total knee arthroplasty

Meeting Abstract

Suche in Medline nach

  • N. Helmy - Universität Zürich, Uniklinik Balgrist, Zürich, Switzerland
  • N. Greidanus - University of British Columbia, Vancouver General Hospital, Vancouver, Canada
  • B. Masri - University of British Columbia, Vancouver General Hospital, Vancouver, Canada
  • C. Anglin - University of Calgary, Centre for Bioengineering Research & Education, Calgary, Alberta, Canada

Deutscher Kongress für Orthopädie und Unfallchirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 94. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 49. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 22.-25.10.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocPO13-31

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dkou2008/08dkou662.shtml

Veröffentlicht: 16. Oktober 2008

© 2008 Helmy et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background: The management of the patellar articular surface at the time of primary total knee arthroplasty is controversial. The purpose of this study was to determine the optimal management strategy (resurfacing versus non-resurfacing), with the use of expected-value decision analysis.

Methods: Outcome probabilities and utility values were determined using data from randomized controlled trials only. A decision tree was constructed and fold-back analysis was performed to evaluate for the optimal path of treatment. Sensitivity analyses were performed to determine the effect on decision-making of varying outcome probabilities and utilities.

Results: Our model showed that patellar resurfacing is the optimal management strategy for the patella at the time of primary TKA. This decision is robust to changes in the specific data, as the optimal path would remain the same as long as the incidence of persistent anterior knee pain with resurfacing remains 29% (current mean, 12%). Delayed (i.e. secondary) patellar resurfacing for ongoing patellar pain provides inferior results for the majority of patients. Of the patients who did not receive patellar resurfacing at the index procedure and who underwent secondary resurfacing due to anterior knee pain, 39% experienced an improvement in their expected health utility from 0.52 to 0.59. However, for the remaining 61%, persistent pain coupled with the second operation resulted in a drop in the expected utility to 0.42.

Conclusions: In this decision analysis the optimal management path for the majority of patients is to resurface the patella at the time of the index arthroplasty procedure. Sensitivity analyses demonstrated that only in unusual clinical circumstances would non-resurfacing be associated with a superior outcome. Secondary resurfacing is not advocated, since the benefit experienced by some patients following late resurfacing does not offset the disutility experienced by all patients undergoing the second operation.

Level of Evidence: Decision analysis - Level I