TAILIEUCHUNG - Tái tạo bề mặt xương bánh chè ở đầu gối

Hay không lại nổi lên xương bánh chè khi thực hiện một arthroplasty tổng đầu gối chính vẫn còn là một câu hỏi mở. Một số nghiên cứu gần đây đã thêm thông tin mới liên quan đến tranh cãi này. Các nghiên cứu giải phẫu cho thấy rằng thường có biến đổi đáng kể trong giải phẫu của các rãnh trochlear. | Perspectives on Modern Orthopaedics Patellar Resurfacing in Total Knee Arthroplasty Robert L. Barrack MD and Michael W. Wolfe MD Abstract Whether or not to resurface the patella when performing a primary total knee arthroplasty remains an open question. A number of recent studies have added new information relevant to this controversy. Anatomic studies show that there is normally substantial variability in the anatomy of the trochlear groove. Implanting a femoral component therefore results in a change in the surface topography of the knee in a high percentage of cases. Even though a number of intraoperative techniques have been described in an attempt to accurately reproduce femoral and tibial component rotation studies of the application of these techniques reveal that component malpositioning or malrotation of a measurable degree occurs in 10 to 30 of cases depending on the surgical technique and landmarks used. There has been substantial change in the design of both femoral and patellar components in recent years. Even with current designs biomechanical studies indicate that some degree of change in kinematics and contact stresses occurs following total knee arthroplasty. However the results of clinical studies have been extremely variable with most showing either no difference or very little difference between resurfaced and nonresurfaced patellae in osteoarthritic knees. The decision to resurface the patella or not must be individualized on the basis of the surgeonÕs training and experience and an intraoperative assessment of the patellofemoral articulation. J Am Acad Orthop Surg 2000 8 75-82 rotation or suboptimal design of the femoral component therefore many of these knees would have failed even if the patella had not been resurfaced. As a result numerous changes in surgical technique and component design have occurred in the past decade. These changes have had a significant impact on the issue of patellar resurfacing in knee arthroplasty. Thus much of the

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