Download PDF
J Knee Surg 2022; 35(13): 1417-1424
DOI: 10.1055/s-0041-1723980
Original Article

Subchondral Bone Condition and Intraoperative Grading of Cartilage Degeneration Underneath Patella Unrelated to the Clinical Outcome after TKA with Unresurfaced Patella

Hyung Jun Park
1   Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
,
Moon Jong Chang 
1   Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
,
Tae Woo Kim
1   Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
,
Chong Bum Chang
2   Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
,
Kee Soo Kang
1   Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
,
Seung-Baik Kang 
1   Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
› Author Affiliations Funding This study received its financial support from National Research Foundation (grant number 2017M3A9D8063538).
› Further Information
   Permissions and Reprints

Abstract

The degree of cartilage degeneration assessed intraoperatively may not be sufficient as a criterion for patellar resurfacing in total knee arthroplasty (TKA). However, single-photon emission tomography/computed tomography (SPECT/CT) is useful for detecting osteoarthritic involvement deeper in the subchondral bone. The purpose of the study was to determine whether SPECT/CT reflected the cartilage lesion underneath the patella in patients with end-stage osteoarthritis (OA) and whether clinical outcomes after TKA without patellar resurfacing differed according to the severity of patellofemoral (PF) OA determined by visual assessment and SPECT/CT findings. This study included 206 knees which underwent TKA. The degree of cartilage degeneration was graded intraoperatively according to the International Cartilage Repair Society grading system. Subjects were classified into low and high uptake groups according to the degree of bone tracer uptake (BTU) on SPECT/CT in the PF joint. The Feller's patella score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed preoperatively and postoperative 1 and 2 years. The increased BTU in the PF joint was associated with more severe degenerative cartilage changes underneath the patella (p < 0.001). The risk for the presence of denudated cartilage was greater in the high uptake group (odds ratio = 5.89). There was no association between clinical outcomes and visual grading of patellar cartilage degeneration or the degree of BTU on SPECT/CT. The visual assessment of the degree of cartilage degeneration underneath the patella and preoperative SPECT/CT evaluation of the PF joint were not predictive of clinical outcome after TKA with unresurfaced patella.

Keywords

patellofemoral joint - single-photon emission tomography - computed tomography - clinical outcome - total knee replacement


Publication History

Received: 04 September 2020

Accepted: 02 January 2021

Article published online:
19 February 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Burnett RSJ, Boone JL, Rosenzweig SD, Steger-May K, Barrack RL. Patellar resurfacing compared with nonresurfacing in total knee arthroplasty. A concise follow-up of a randomized trial. J Bone Joint Surg Am 2009; 91 (11) 2562-2567
    CrossrefPubMedGoogle Scholar
  • 2 Burnett RS, Bourne RB. Indications for patellar resurfacing in total knee arthroplasty. Instr Course Lect 2004; 53: 167-186
    PubMedGoogle Scholar
  • 3 He J-Y, Jiang L-S, Dai L-Y. Is patellar resurfacing superior than nonresurfacing in total knee arthroplasty? A meta-analysis of randomized trials. Knee 2011; 18 (03) 137-144
    CrossrefPubMedGoogle Scholar
  • 4 Roberts DW, Hayes TD, Tate CT, Lesko JP. Selective patellar resurfacing in total knee arthroplasty: a prospective, randomized, double-blind study. J Arthroplasty 2015; 30 (02) 216-222
    CrossrefPubMedGoogle Scholar
  • 5 Rodríguez-Merchán EC, Gómez-Cardero P. The outerbridge classification predicts the need for patellar resurfacing in TKA. Clin Orthop Relat Res 2010; 468 (05) 1254-1257
    CrossrefPubMedGoogle Scholar
  • 6 Bourne RB, Burnett RSJ. The consequences of not resurfacing the patella. Clin Orthop Relat Res 2004; (428) 166-169
    CrossrefPubMedGoogle Scholar
  • 7 Cho W-J, Bin S-I, Kim J-M, Lee B-S, Sohn D-W, Kwon Y-H. Total knee arthroplasty with patellar retention: the severity of patellofemoral osteoarthritis did not affect the clinical and radiographic outcomes. J Arthroplasty 2018; 33 (07) 2136-2140
    CrossrefPubMedGoogle Scholar
  • 8 Eshnazarov KE, Seon JK, Song EK. Comparison of radiological assessments patellar resurfacing with retention for grade IV osteoarthritis in patellofemoral joint accomplished total knee arthroplasty. Vestn Rentgenol Radiol 2016; 97 (01) 28-32
    CrossrefPubMedGoogle Scholar
  • 9 Seo SS, Kim CW, Moon SW. A comparison of patella retention versus resurfacing for moderate or severe patellar articular defects in total knee arthroplasty: minimum 5-year follow-up results. Knee Surg Relat Res 2011; 23 (03) 142-148
    CrossrefPubMedGoogle Scholar
  • 10 Raaij TMV, Meij EV, Vries AJ, Raay JJAMV. Patellar resurfacing does not improve clinical outcome in patients with symptomatic tricompartmental knee osteoarthritis. An RCT study of 40 patients receiving primary cruciate retaining total knee arthroplasty. J Knee Surg 2020
    PubMedGoogle Scholar
  • 11 Ro H, Lee HY, Chang CB, Kang SB. Value of SPECT-CT imaging for middle-aged patients with chronic anterior knee pain. BMC Musculoskelet Disord 2015; 16 (01) 169
    CrossrefPubMedGoogle Scholar
  • 12 Hirschmann A, Hirschmann MT. Chronic knee pain: clinical value of MRI versus SPECT/CT Semin Musculoskelet Radiol. 2016; 003-011
    PubMedGoogle Scholar
  • 13 Maas O, Joseph GB, Sommer G, Wild D, Kretzschmar M. Association between cartilage degeneration and subchondral bone remodeling in patients with knee osteoarthritis comparing MRI and (99m)Tc-DPD-SPECT/CT. Osteoarthritis Cartilage 2015; 23 (10) 1713-1720
    CrossrefPubMedGoogle Scholar
  • 14 Dordevic M, Hirschmann MT, Rechsteiner J, Falkowski A, Testa E, Hirschmann A. Do chondral lesions of the knee correlate with bone tracer uptake by using SPECT/CT?. Radiology 2016; 278 (01) 223-231
    CrossrefPubMedGoogle Scholar
  • 15 Hirschmann MT, Rasch H, Murer M, Rotigliano N. SPECT/CT imaging of the meniscus and cartilage: what does it offer? In: Surgery of the Meniscus. Springer; 2016: 163-168
    Google Scholar
  • 16 Kim J, Kim YK, Oh SW, Chai JE. Clinical significance of knee SPECT/CT in the evaluation of patellofemoral joint of patients with chronic anterior knee pain. J Nucl Med 2016; 57 (Suppl. 02) 1909
    PubMedGoogle Scholar
  • 17 Scott RD. Femoral and tibial component rotation in total knee arthroplasty: methods and consequences. Bone Joint J 2013; 95-B (11, Suppl A): 140-143
    CrossrefPubMedGoogle Scholar
  • 18 Insall JN, Binazzi R, Soudry M, Mestriner LA. Total knee arthroplasty. Clin Orthop Relat Res 1985; (192) 13-22
    PubMedGoogle Scholar
  • 19 Cerciello S, Robin J, Lustig S, Maccauro G, Heyse TJ, Neyret P. The role of patelloplasty in total knee arthroplasty. Arch Orthop Trauma Surg 2016; 136 (11) 1607-1613
    CrossrefPubMedGoogle Scholar
  • 20 Li T, Zhou L, Zhuang Q, Weng X, Bian Y. Patellar denervation in total knee arthroplasty without patellar resurfacing and postoperative anterior knee pain: a meta-analysis of randomized controlled trials. J Arthroplasty 2014; 29 (12) 2309-2313
    CrossrefPubMedGoogle Scholar
  • 21 Yuenyongviwat V, Iamthanaporn K, Hongnaparak T. Lateral facetectomy decreased patellofemoral contact pressure in total knee replacement: a cadaveric study. J Clin Orthop Trauma 2017; 8 (01) 82-84
    CrossrefPubMedGoogle Scholar
  • 22 Zhang L-Z, Zhang X-L, Jiang Y, Wang Q, Chen Y-S, Shen H. Lateral patellar facetectomy had improved clinical results in patients with patellar-retaining total knee arthroplasty. J Arthroplasty 2012; 27 (08) 1442-1447
    CrossrefPubMedGoogle Scholar
  • 23 Cho W-S, Woo J-H, Park H-Y, Youm Y-S, Kim B-K. Should the ‘no thumb technique’ be the golden standard for evaluating patellar tracking in total knee arthroplasty?. Knee 2011; 18 (03) 177-179
    CrossrefPubMedGoogle Scholar
  • 24 Hirschmann MT, Iranpour F, Davda K, Rasch H, Hügli R, Friederich NF. Combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT): clinical value for the knee surgeons?. Knee Surg Sports Traumatol Arthrosc 2010; 18 (03) 341-345
    CrossrefPubMedGoogle Scholar
  • 25 Mainil-Varlet P, Aigner T, Brittberg M. et al; International Cartilage Repair Society. Histological assessment of cartilage repair: a report by the Histology Endpoint Committee of the International Cartilage Repair Society (ICRS). J Bone Joint Surg Am 2003; 85-A (Suppl. 02) 45-57
    CrossrefPubMedGoogle Scholar
  • 26 Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15 (12) 1833-1840
    PubMedGoogle Scholar
  • 27 Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br 1996; 78 (02) 226-228
    CrossrefPubMedGoogle Scholar
  • 28 Clement ND, Bardgett M, Weir D, Holland J, Gerrand C, Deehan DJ. What is the minimum clinically important difference for the WOMAC index after TKA?. Clin Orthop Relat Res 2018; 476 (10) 2005-2014
    CrossrefPubMedGoogle Scholar
  • 29 Bito H, Takeuchi R, Kumagai K. et al. Opening wedge high tibial osteotomy affects both the lateral patellar tilt and patellar height. Knee Surg Sports Traumatol Arthrosc 2010; 18 (07) 955-960
    CrossrefPubMedGoogle Scholar
  • 30 Singh J, Sloan JA, Johanson NA. Challenges with health-related quality of life assessment in arthroplasty patients: problems and solutions. J Am Acad Orthop Surg 2010; 18 (02) 72-82
    CrossrefPubMedGoogle Scholar
  • 31 Allen KD, Golightly YM. State of the evidence. Curr Opin Rheumatol 2015; 27 (03) 276-283
    CrossrefPubMedGoogle Scholar
  • 32 Fransen M, Bridgett L, March L, Hoy D, Penserga E, Brooks P. The epidemiology of osteoarthritis in Asia. Int J Rheum Dis 2011; 14 (02) 113-121
    CrossrefPubMedGoogle Scholar
  • 33 Vina ER, Kwoh CK. Epidemiology of osteoarthritis: literature update. Curr Opin Rheumatol 2018; 30 (02) 160-167
    CrossrefPubMedGoogle Scholar
  • 34 Lee C-H, Ha C-W, Kim S, Kim M, Song Y-J. A novel patellofemoral scoring system for patellofemoral joint status. J Bone Joint Surg Am 2013; 95 (07) 620-626
    CrossrefPubMedGoogle Scholar