Functional Outcome of Patients with Malignant Tumors around the Knee Treated by Modular Endoprosthesis: A Comparative Study between Patellar Resurfacing and Nonresurfacing

W. Ebeid, Mohamed Taha A. Mehanna, Mohamed Saleh Moustafa, Khaled Mohamed Ahmed Abo ElNasr, Sameh Mahmoud Abo ElFadl
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Abstract

Patellar resurfacing with knee arthroplasty has always been controversial. The literature contains data that support both resurfacing and not resurfacing the patella. However, the literature does not review a lot of studies that address the impact of patellar resurfacing on the functional outcome following resection of distal femur tumors and limb salvage using modular prosthesis. Is patellar resurfacing better than nonresurfacing as regards functional outcome of modular prosthesis used for the treatment of tumors around the knee? Two groups of patients; both were subjected to wide excision of tumors around the knee and limb salvage using modular prosthesis. The first group underwent reconstruction with patellar resurfacing, while the second underwent reconstruction without patellar resurfacing. The age of these groups of patients ranged from 11 to 71 years. The patients were 17 males and 19 females. We evaluated patients using the musculoskeletal tumor society scoring system (MSTS), knee society final score, knee society function score, and anterior knee pain score. We found that MSTS functional score, knee society final score and knee society function score, and anterior knee pain score were all better in patients who underwent patellar resurfacing compared to nonresurfacing patients. However, only the difference in anterior knee pain score was statistically significant (P = 0.030). Differences in other scores between these two groups were all statistically insignificant (P value of the MSTS difference = 0.103, P value of the knee society final score difference = 0.423, and P value of the knee society function score difference = 0.337). Patellar resurfacing could be helpful in decreasing anterior knee pain and the necessity to future surgeries addressing patellofemoral pain, especially in revision cases, patients with patellofemoral problems, and patients with extensor mechanism weakness and those with anterior knee pain. Since Anterior Knee Pain Scale was the only scoring system, among all scoring systems used, that confirmed a significant impact of patellar resurfacing on the outcome following resections and reconstructions; we cannot give an explicit strong recommendation favoring the routine patellar resurfacing in all cases undergoing resections and reconstructions using modular prosthesis. We recommend patellar resurfacing in older patients, based on our results, which show possible benefit of patellar resurfacing in older patients. We think that old age and the preexisting knee arthritis could be relative indications for patellar resurfacing.
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采用模块化内固定治疗膝关节周围恶性肿瘤患者的功能预后:髌骨复位与非复位比较研究
膝关节置换术中的髌骨复位一直存在争议。文献中包含支持或不支持髌骨复位的数据。然而,对于股骨远端肿瘤切除和使用模块化假体进行肢体救治后,髌骨复位对功能结果的影响,文献中并没有大量的研究综述。 就用于治疗膝关节周围肿瘤的模块化假体的功能效果而言,髌骨置换是否优于非置换? 两组患者均接受了膝关节周围肿瘤的广泛切除术,并使用模块化假体进行肢体修复。第一组患者进行了髌骨复位重建,第二组患者则没有进行髌骨复位重建。这两组患者的年龄从 11 岁到 71 岁不等。患者中有 17 名男性和 19 名女性。我们使用肌肉骨骼肿瘤协会评分系统(MSTS)、膝关节协会最终评分、膝关节协会功能评分和膝关节前部疼痛评分对患者进行了评估。 我们发现,与未接受髌骨复位手术的患者相比,接受髌骨复位手术的患者的MSTS功能评分、膝关节社会最终评分和膝关节社会功能评分以及膝关节前部疼痛评分都更好。然而,只有膝关节前部疼痛评分的差异具有统计学意义(P = 0.030)。两组患者的其他评分差异均无统计学意义(MSTS 差异的 P 值 = 0.103,膝关节协会最终评分差异的 P 值 = 0.423,膝关节协会功能评分差异的 P 值 = 0.337)。 髌骨复位术有助于减轻膝关节前部疼痛,并减少今后针对髌骨股骨疼痛进行手术的必要性,尤其适用于翻修病例、髌骨股骨问题患者、伸肌无力患者和膝关节前部疼痛患者。由于膝关节前侧疼痛量表是所有评分系统中唯一证实髌骨复位对切除和重建手术后疗效有显著影响的评分系统,因此我们无法明确强烈建议所有使用模块化假体进行切除和重建的病例都常规进行髌骨复位。根据我们的研究结果,我们建议对老年患者进行髌骨复位,因为我们的研究结果表明,对老年患者进行髌骨复位可能会带来益处。我们认为,老年和原有的膝关节炎可能是髌骨重置术的相对适应症。
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来源期刊
Journal of Arthroscopy and Joint Surgery
Journal of Arthroscopy and Joint Surgery Medicine-Orthopedics and Sports Medicine
CiteScore
0.60
自引率
0.00%
发文量
1
期刊介绍: Journal of Arthroscopy and Joint Surgery (JAJS) is committed to bring forth scientific manuscripts in the form of original research articles, current concept reviews, meta-analyses, case reports and letters to the editor. The focus of the Journal is to present wide-ranging, multi-disciplinary perspectives on the problems of the joints that are amenable with Arthroscopy and Arthroplasty. Though Arthroscopy and Arthroplasty entail surgical procedures, the Journal shall not restrict itself to these purely surgical procedures and will also encompass pharmacological, rehabilitative and physical measures that can prevent or postpone the execution of a surgical procedure. The Journal will also publish scientific research related to tissues other than joints that would ultimately have an effect on the joint function.
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