Značaj zamene zglobne površine čašice u totalnoj artroplastici kolena kod valgusnih degenerativnih deformiteta

Abstract

Totalna artroplastika kolena je jedna od najčešćih i najuspešnijih hirurških procedura. Zamena zglobne površine čašice tokom ove procedure nije univerzalno prihvaćena. Valgusni degenerativni deformitet praćen je većom učestalošću komplikacija izazvanih problemima sa čašicom nakon totalne artroplastike kolena. U literaturi nema radova koji ispituju uticaj zamene zglobne površine čašice u ovom tipu deformiteta na rezultat totalne artroplastike kolena. Metod Prospektivna klinička hospitalna studija obuhvatila je 60 pacijenata sa valgusnim degenerativnim deformitetom kolena i degenerativnim promenama čašice, lečenih totalnom artroplastikom kolena na Institutu za ortopedsko hirurške bolesti „Banjica“ u Beogradu u periodu od 2011. - 2016. godine. Pacijenti su podeljeni u grupu pacijenata kod kojih je zamenjena zglobna površina čašice i u grupu pacijenata kod kojih ova zamena nije izvedena. Rezultati lečenja mereni su u pravilnim vremenskim razmacima tokom perioda praćenja od dve godine. Analizirani su funkcionalni rezultati na osnovu Knee Society Score i Oxford Knee Score kao i prisustvo i intenzitet bola. Rezultati Ispitivane grupe nisu se razlikovale u pogledu preoperativnih karakteristika. Značajnost razlike u rezultatima nadjena je kada je u pitranju Oxford Knee Score u korist grupe pacijenata kod kojih je primenjena zamena zglobne površine čašice nakon perioda praćenja od 6 meseci. U ostalim ispitivanim parametrima nije nadjena statistički značajna razlika. Zaključak Ukupna učestalost patelarnih komplikacija nakon totalne artroplastike kolena zbog valgusnog degenerativnog deformiteta je mala. Ustanovljena značajnost razlike u rezultatu lečenja u korist pacijenata kod kojih je zamenjena zglobna površina čašice mogla bi biti od koristi pri selekciji pacijenata koji bi imali koristi od zamene zglobne površine čašice tokom totalne artroplastike kolena.

Total knee arthroplasty is among most successfull surgical procedures. Patellar surface replacement during total knee arthroplasty is not universally accepted among orthopedic surgeons. Treatment of valgus knee deformity is accompanied with greater incidence of complications caused by patellar dysfunction after total knee arthroplasty. In the literature we didn't find any study that would compare results of patella management solely for valgus or varus knee deformity. Methods: This was prospective clinical hospital study which included 60 patients with symptomatic valgus degenerative knee deformity treated with total knee arthroplasty at the Institute for orthopaedic sugery “Banjica” in Belgrade in the period between 2011. and 2016. Patients were randomly assigned to a group that would receive patellar surface replacement during total knee arthroplasty and a group of patients in whom total knee arthroplasty was performed without patellar surface replacement. Results were prospectively gathered and compared at regular intervals during postoperative period of two years. Functional results were analyzed through Knee Society Score and Oxford Knee Score and presence and intensity of pain through Visual Analogue Scale. Results: There were no significant differences between groups for questioned parameters except for Oxford Knee Score at 6 months which was in favor of patellar resurfacing group. In all other examined parameters there were no significant differences among groups. Conclusions: Overall patellar complications following total knee arthroplasty in valgus degenerative deformity in this study were rare. Significant difference that was found in treatment results in one parameter in favour of patients with patellar resurfacing, could be useful in establishing selection criteria for patients which would benefit from patella resurfacing during total knee arthroplasty.