Cemil ERTÜRK, MEHMET AKİF ALTAY, Uğur Erdem IŞIKAN

Total diz artroplastisinde ön diz ağrısını gidermek için patella içi basıncın azaltılması ve patelloplasti uygulaması

Amaç: Total diz artroplastisi (TDA) sonrası, ön diz ağrısı önemli bir sorundur. Bu çalışmada Evre 4 diz osteoartritinde TDA uygulanan hastaların ön diz ağrısını gidermek için patella içi basıncın drillenerek azaltılması ile birlikte patelloplasti uygulamasının erken sonuçlarını değerlendirmeyi amaçladık. Çalışma planı: Toplam 46 hastanın (35 kadın, 11 erkek; ortalama yaş 69.2; dağılım: 54-82) Ocak 2004 ve Aralık 2008 tarihleri arasında TDA uygulanmış 49 dizi ileriye dönük olarak değerlendirildi. Ameliyatta Outerbridge sınıflamasına göre, Evre 3 ve 4 kıkırdak hasan olan patel-lalara dekompresyon ve patelloplasti uygulandı. Olgular ameliyattan önce ve son kontrolde. Diz Derneği'nin (Knee Society) diz ve fonksiyon puanlarıyla, patella skoru ise Feller'in patellofemo-ral ağrı sorgulamasına göre değerlendirildi. Dizlerin hareket açıklığı (range of motion, ROM) ölçüldü. Ayrıca, en son kontrolde hastalar Levitsky'nin hasta memnuniyet formu ile sorgulandı. Ortalama takip süresi 41.1 (dağılım: 24-68) ay idi. Bulgular: Ameliyat öncesi ve son kontrolde total diz skoru sırasıyla 48.6±8.8 ve 87.70±9.3. fonksiyon skorlan 48.4±10.4 ve 8I.4±12.6 bulundu. Patella skoru ameliyat öncesi 18.1 ±3.5 ve son kontrolde 25.7±2.8 idi. Evre 3 kıkırdak hasan olan dizlerin patella skoru (26.47±2.38). Evre 4 olanlara (24.29±3.19) göre anlamlı derecede yüksekti. Dört (%8.2) dizde ön diz ağrısı saptandı. Ameliyat Öncesi diz hareket açıklığı ortalama 85.1±12.7 iken, son kontrolde 117.0±9.8 ölçüldü. Olguların %93.8'i alınan sonuçtan memnundu. Çıkarımlar: Ön diz ağrısını azaltmak için patella içi basıncın azaltılması ile patelloplasti uygulamasının, literatürde bildirilen patella yüzeyi değiştirilen ya da değiştirilmeyen yöntemlere üstün olduğuna dair önemli bir kanıt bulunamamıştır.

Patelloplasty with patellar decompression to relieve anterior knee pain in total knee arthroplasty

Objective: Anterior knee pain continues to be an important problem following total knee arthroplasty (TKA). The aim of this study was to present the early results of patelloplasty with patellar decompression to relieve anterior knee pain in patients who undergo TKA. Methods: We prospectively reviewed 49 knees from 46 patients (35 females, 11 males; mean age: 69.2 years; range: 54 to 82 years) who underwent TKA between January 2004 and December 2008. Decompression and patelloplasty were performed in patients in whom Grade 3 and 4 chondropathy was detected during operation according to the Outerbridge classification. All knees were rated according to the Knee Society Knee and Function Scores, before surgery and during the final follow-up. The patella score was evaluated according to a specific patellofemoral pain questionnaire used by Feller, and the mean knee range of motion was measured preoperatively and postoperatively. Additionally, a patient satisfaction questionnaire used by Levitsky was performed during the final follow-up exam. The mean follow-up period was 41.1 (range: 24 to 68) months. Results: The mean preoperative and final follow-up knee scores were 48.6±8.8 and 87.70±9.3, and function scores were 48.4±10.4 and 81.4±12.6, respectively. The mean preoperative patellar score was 18.1±3.5, and the final follow-up patellar score was 25.7±2.8. The mean patellar scores were significantly greater in knees with Grade 3 chondropathy compared to Grade 4 chondropathy (26.47±2.38 and 24.29±3.19, respectively). Postoperative anterior knee pain was present in four knees (8.2%). The mean preoperative knee range of motion was 85.1±12.7, and the final follow- up knee range of motion was 117.0±9.8. Patients were "extremely" or "very" satisfied with 93.8% of their operative outcomes on their knees. Conclusion: Patellar decompression with patelloplasty in TKA is an option for the reduction of anterior knee pain, but its superiority to patellar resurfacing and patellar retention methods reported in the literature is not evident.

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