Anterior knee pain in patients following total knee arthroplasty: the prevalence, correlation with patellar cartilage impairment and aspects of patellofemoral congruence
Kuupäev
2015-01-16
Autorid
Ajakirja pealkiri
Ajakirja ISSN
Köite pealkiri
Kirjastaja
Abstrakt
Eesmine põlvevalu (EPV) põhjustab rahulolematust rohkem kui poolel põlve endoproteesiga patsientidest. Seni ei ole Eestis põlveproteesiga patsientidel EPV levimust hinnatud. Käesolevas töös uuriti EPV levimust põlvekedra liigespinda säilitades endoproteesitud põlveliigesega patsientidel Ida-Tallinna Keskhaiglas. Patsiendi esitatud andmete alusel diagnoositi EPV 20,2% juhtudest, arsti täidetava küsimustiku kasutamisel ilmnes, et EPV levimus on 60%. Patsiendi sugu, põlveproteesi säärekomponendi mobiilsus ja Outerbridge’i 4. staadiumi kõhredefektid ei mõjuta EPV levimust põlvekedra liigespinna asendamiseta teostatud põlveproteesimise järel.
EPV on põhjustatud mitmest tegurist, üks võimalikest põhjustajatest on põlvekedra kõhre kahjustus. Senistes uuringutes on saadud vastakaid tulemusi põlve endoproteesimise käigus täheldatavate patella kõhre silmaga nähtavate muutuste ja operatsioonijärgse EPV seose kohta. Makroskoopilisele kahjustusele eelnevad muutused rakkude tasandil ja ainult makroskoopiliste kõhremuutuste hindamine ei pruugi anda kõhre seisundist terviklikku pilti. Seepärast kasutati käesolevas töös põlvekedra kõhre seisundi hindamiseks OARSI metoodikat, kus on ühendatud kõhrekahjustuse sügavuse mikroskoopiline analüüs ja muutuste leviku pindala makroskoopiline hindamine. Uuringust selgus, et EPV patsientidel on OARSI skoor suurem ja et suurema OARSI skooriga patsientidel on EPV risk suurem.
EPV patsiendi kliiniline uurimine sisaldab ka röntgeniülesvõtete tegemist. Tänapäeval puudub röntgenmetoodika, mis võimaldaks aksiaaltasapinnas valiidselt ja reliaabselt hinnata põlveproteesiga patsientidel patella asendit reie interkondülaarvao suhtes. Töötasime välja uue patellofemoraalse aksiaaltasapinnalise kongruentsuse hindamise röntgenmeetodi – põlvekedra nihkeindeksi (PNI), mille arvutamiseks on põlveproteesiga patsiendil kõik orientiirid alati hästi eristatavad. PNI ei sõltu röntgenoloogilisest suurendusest ega põlveproteesi mõõtudest ning on kasutatav nii digitaalsete kui ka trükitud röntgenipiltide korral.
Anterior knee pain (AKP) is the cause of dissatisfaction with an artificial joint in more than half of patients following total knee arthroplasty (TKA). The prevalence of AKP following TKA has not been studied in Estonia before. We estimated the prevalence of AKP in patients who had undergone TKA without patellar resurfacing in East-Tallinn Central Hospital. We diagnosed a 20.2% prevalence of AKP in a postal survey based solely on patient reported data and a 60% prevalence of AKP using physician specific information. A patients’ gender, mobility of the tibial insert and Outerbridge grade 4 cartilage defects of the patella diagnosed at knee replacement did not predict the incidence of postsurgical AKP following TKA without patellar resurfacing. The etiology of AKP is multifactorial and degeneration of the articular cartilage of the patella may be one of the causes. Histological changes precede macroscopic degeneration of the cartilage and this is why only a visual inspection may lead to improper conclusions regarding the condition of the cartilage. We evaluated the state of the patellar cartilage during TKA with the OARSI score, which combines the histologic assessment of depth with a visual inspection of the extent of cartilage impairment. We discovered that the OARSI score of the patellar cartilage correlates positively with postoperative AKP following TKA with unresurfaced patella. Patients with greater patella cartilage impairment, as expressed by higher OARSI scores, have a higher risk of AKP. Resection of the joint surfaces during knee replacement and stress-induced remodelling of the unresurfaced patella distort the landmarks necessary for measuring patellofemoral congruence using current methods. We introduced a reliable new radiographic measurement of patellofemoral congruence that evaluates patellar alignment in the axial plane following TKA with unresurfaced patella – the patellar shift index (PSI). The necessary landmarks for the calculation of PSI are always present and easily discernible. PSI is independent of radiographic magnification or knee dimensions and is applicable on different media such as digital images and printed radiographs.
Anterior knee pain (AKP) is the cause of dissatisfaction with an artificial joint in more than half of patients following total knee arthroplasty (TKA). The prevalence of AKP following TKA has not been studied in Estonia before. We estimated the prevalence of AKP in patients who had undergone TKA without patellar resurfacing in East-Tallinn Central Hospital. We diagnosed a 20.2% prevalence of AKP in a postal survey based solely on patient reported data and a 60% prevalence of AKP using physician specific information. A patients’ gender, mobility of the tibial insert and Outerbridge grade 4 cartilage defects of the patella diagnosed at knee replacement did not predict the incidence of postsurgical AKP following TKA without patellar resurfacing. The etiology of AKP is multifactorial and degeneration of the articular cartilage of the patella may be one of the causes. Histological changes precede macroscopic degeneration of the cartilage and this is why only a visual inspection may lead to improper conclusions regarding the condition of the cartilage. We evaluated the state of the patellar cartilage during TKA with the OARSI score, which combines the histologic assessment of depth with a visual inspection of the extent of cartilage impairment. We discovered that the OARSI score of the patellar cartilage correlates positively with postoperative AKP following TKA with unresurfaced patella. Patients with greater patella cartilage impairment, as expressed by higher OARSI scores, have a higher risk of AKP. Resection of the joint surfaces during knee replacement and stress-induced remodelling of the unresurfaced patella distort the landmarks necessary for measuring patellofemoral congruence using current methods. We introduced a reliable new radiographic measurement of patellofemoral congruence that evaluates patellar alignment in the axial plane following TKA with unresurfaced patella – the patellar shift index (PSI). The necessary landmarks for the calculation of PSI are always present and easily discernible. PSI is independent of radiographic magnification or knee dimensions and is applicable on different media such as digital images and printed radiographs.
Kirjeldus
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Märksõnad
patellofemoraalne valusündroom, põlveliiges, tehisliigesed, põlvekeder, kõhrehaigused, patellofemoral pain syndrome, knee joint, artificial joints, patella, cartilage diseases