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O. Courage, L. Malekpour
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Conclusion
The debate on whether or not to resurface the
patella in prosthetic surgery of the knee has to
this day not been clear-cut. It is notable that the
pain from patellofemoral conflict is difficult to
isolate.
Despite the low number of patients, our study
being dedicated to only one trochlear shape
while focusing on any patellar shape, it was
found that pain at 1 year is accompanied by
major incompatibility between the native
patella and prosthetic plate.
We suggest detecting major patellofemoral
incongruencies pre-operatively, particularly
through utilisation of drawings to assist in the
decision between non-resurfacing, patelloplasty
or resurfacing of the patella.
Abstract
Nowadays the indication for patellar resurfacing
in prosthetic knee surgery is controversial, the
literature results on the subject being
contradictory at times. While the decision for
resurfacing ought to depend on risk-benefit
reports for the patient, this seems rather linked
to the personal preferences of the surgeon
dependent on his training.
A less studied question concerns the notion of
patellofemoral congruency between femoral
implants and native patellae, which is subject
to anatomical variation. Thus the question may
be raised concerning the consequences of
congruency defects on the results.
The goal of this study is to observe, by
arthroscopy and radiology, the congruency
between native patellae of different shapes with
a single femoral implant, and to evaluate the
differences in clinical results at one year
relating to the congruency observed.
The evaluation was carried out at the same
centre. The operation was performed by the
same surgeon. 17 patients, having given their
informed consent, were selected according to
predefined inclusion and exclusion criteria.
The access, mid-vastus with preservation of the
Hoffa, was the same for each patient.
The 17 patients were separated into three
groups depending on the shape of their patella
according to the Wiberg classification. The
prosthetic implant used was the same for each
operation, the patellae were not resurfaced.
Patellofemoral congruency was evaluated by
arthroscopy at the moment of closure, with the
knee at 45° of flexion, without water. Each case
was analysed by radiography.
The patients were reviewed again on average at
1 year, with clinical and radiological evaluation.
Patellae of different shapes with the same
femoral plate do not systematically result in
patellofemoral
incongruency.
Patients
presenting with patellofemoral incongruency
appear to present with increased anterior pain
at 1 year.