髌股关节置换术与全膝关节置换术治疗单纯髌股关节骨关节炎的Meta分析

目的目的比较髌股关节置换术（PFA）与全膝关节置换术（TKA）治疗单纯髌股关节骨关节炎（PFOA）的失败率,评价两种不同治疗选择的疗效差异。方法检索Medline、Embase、CBM数据库,收集单纯髌股关节骨关节炎（PFOA）行PFA或TKA的临床试验,提取数据,采用Meta—Analyst3．13进行Meta分析。结果纳入39个回顾性临床试验,髌股关节置换1599膝,全膝关节置换患267膝。总的PFA组（包括第一代、第二代PFA）失败率13．6％[95％CI（0．103,0．176）];TKA组失败率1．8％[95％CI（0．007,0．044）];第一代PFA假体失败率19％[95％CI（0．143,0．247）];第二代PFA假体失败率8．3％[95％CI（0．053,0．128）]。结论PFOA患者行PFA的失败率比TKA高,需要再手术或翻修,这与假体设计和适应证的选择有关。第二代PFA假体翻修率与第一代相比明显降低。

Meta-analysis of patellofemoral arthroplasty and total knee arthroplasty in treatment of isolated patellofemoral osteoarthritis

Objective To compare the incidence of failure following patellofemoral arthroplasty （PFA） and total knee arthroplasty （TKA） for isolated patellofemoral osteoarthritis and evaluate the efficacy of the two different treatment options. Methods The publications with patients who underwent PFA or TKA for patellofemoral osteoarthritis were systematically identified from the database of Chinese Biomedical Database, Medline and Embase. The data of demographics, implants （TKA, first or second-generation PFA）, and revision rate were collected. Meta-Analyst3.13 software was used to analyse the data. Results 39 trials were included （ 1599 knees in PFA group/267 knees in TKA group） in this study. The Meta- analysis showed the failure rate in PFA group （including 1st generation PFA and 2nd generation PFA） was 13.6% [95% CI （0. 103, 0. 176） ]. The failure rate of TKA group was 1.8% [95% （0. 007, 0. 044） ]. The subgroup analysis showed that the 1st generation PFA failure was 19% [95% CI （0. 143, 0. 247） 1 and the 2nd generation PFA failure rate was 8.3% [ 95% CI （ 0. 053, 0. 128 ） ]. Conclusion The patellofemoral arthroplasy has higher failure rate than total knee arthroplasty in the treatment of isolated patellofemoral osteoarthritis, which is related to implant design and patient selection. The revision rate of the 2nd generation PFA is significantly lower than the 1st generation PFA.