摘要
背景：髌股关节置换术对于仅侵犯膝关节前间室的单发性关节炎是一种有效的治疗方法，但是当其需要行翻修手术时，是否会影响人工全膝关节置换术的结果仍不明确。本研究旨在回顾先期行髌股关节置换术后再进行人工全膝关节置换术的结果。
方法：我们用人工全膝关节置换术对10例患者共12膝失败的髌股关节置换进行了翻修，翻修原因，包括单发的进行性胫股关节炎（6膝）、单发的髌股关节轧住和轨迹不良（3膝）以及两者同时存在（3膝）。这些患者在髌股关节置换术后进行翻修术的平均时间为4年，每个膝关节均使用了后稳定型假体，未使用加长柄、填充垫或结构性骨移植物。术后对这些患者进行了临床及影像学随访，其中包括美国膝关节学会临床及功能评分（KSS）。术前我们就对这些失败的髌股关节置换术进行了评估，并获得了术前KSS评分。
结果：术后平均随访时间为3．1年，平均KSS临床评分和功能评分从术前的57分和51分分别增加至术后的96分和91分。在最近的随访中，没有临床和影像学证据表明这些患者存在髌股关节轨迹不良、松动和磨损。
结论：基于我们对本组患者的小样本短期随访经验，髌股关节置换失败后进行人工全膝关节置换翻修术不会影响其结果。
可信水平：治疗性研究，Ⅳ级。进一步可信度参见作者介绍。
Background： Patellofemoral arthroplasty is an effective treatment for isolated arthritis of the anterior compartment of the knee, but it is unclear whether it compromises the results of total knee arthroplasty if revision is necessary. The purpose of this study was to review the results of total knee arthroplasty after a prior patellofemoral arthroplasty.
Methods ： Twelve failed patellofemoral replacements in ten patients were revised to total knee arthroplasties for isolated progressive tibiofemoral arthritis （six knees）, isolated patellofemoral catching and mahracking （three）, or a combination of both （three）. Revisions were performed at a mean of four years after the patellofemoral arthroplasty. A posterior stabilized implant was used in each knee, without a need for stems, augments, or structural bone graft. Patients were assessed by clinical and radiographic follow-up, including Knee Society clinical and functional scores. Baseline preoperative Knee Society scores were obtained at the time of evaluation of the failed patellofemoral arthroplasty.
Results： At a mean follow-up of 3.1 years, the mean Knee Society clinical and functional scores had increased from 57 points preoperatively to 96 points and from 51 points preoperatively to 91 points, respectively. At the most recent fallow-up, there was no clinical or radiogiaphic evidence of patellofemoral maltracking, loosening, or wear.
Conclusions： On the basis of our experience in this relatively small series with short-term follow-up, the results of total knee arthroplasty do not seem to be compromised after revision of the failed patellofemoral replacement.
Level of Evidence： Therapeutic Level Ⅳ. See Instructions to Authors for a complete description of levels of evidence.
