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Patellar resurfacing is associated with reduced postoperative effusion compared with synovectomy in severe chondrocalcinosis undergoing total knee arthroplasty
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DOI：10.1007/s00264-026-06767-6.png)
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Abstract
En 中文
Purpose Regarding patellar resurfacing in total knee arthroplasty (TKA), no consensus has been reached, but most studies have not addressed specific pathological circumstances. Evidence on the roles of patellar resurfacing and synovectomy in managing postoperative effusion in patients with severe chondrocalcinosis is limited. Material and methods This single-centre observational cohort study included 160 patients who underwent the same TKA for osteoarthritis with severe chondrocalcinosis (grade 4) between January 2000 and December 2010. A matched design created four comparable groups of 40 patients each: (1) TKA without patellar resurfacing or synovectomy, (2) TKA with patellar resurfacing alone, (3) TKA with synovectomy alone, and (4) TKA with both patellar resurfacing and synovectomy. Severe chondrocalcinosis (advanced calcium pyrophosphate deposition disease) was confirmed through radiographic findings, synovial fluid analysis using polarized light microscopy, and histology. Significant postoperative effusion was diagnosed with ultrasound, quantified by sterile joint aspiration, and classified as stage I (10-20 cm(3)), stage II (21-30 cm(3)), or stage III (> 30 cm(3)). Results Postoperative joint effusion varied significantly between the strategies. In the patellar resurfacing group, 25% (10/40) of patients developed only stage I effusion without synovectomy. Conversely, 45% (18/40) of patients in the synovectomy-only group developed stage II effusion, while 62.5% (25/40) of patients without either procedure developed stage III effusion (p < 0.0001). TKA with both patella resurfacing and synovectomy resulted in either stage I (7/40) or stage II effusion (6/40). Multivariate regression confirmed patellar resurfacing as an independent protective factor against postoperative effusion (p < 0.01). Average aspirated effusion volumes further supported these findings: 39 +/- 6 cm(3) for TKA without additional procedures, 18 +/- 8 cm(3) with synovectomy, 6 +/- 4 cm(3) with patellar resurfacing, and 7 +/- 4 cm(3) with both patellar resurfacing and synovectomy. The results showed that as total knee effusion volume increased, inflammatory markers (C-reactive protein level) increased, and range of motion decreased. Conclusion In severe chondrocalcinosis, patellar resurfacing may be appropriate to prevent joint effusion after TKA.
Keywords:
Patella resurfacing
Chondrocalcinosis
Total knee arthroplasty
Joint effusion
Synovectomy
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