膝蓋骨非置換人工膝関節置換術を施行後5カ月で膝蓋骨の置換手術が行われた1例

Patellar Resurfacing 5 Months after Total Knee Arthroplasty without Patellar Resurfacing. Case Report

　膝蓋骨非置換人工膝関節置換術(TKA)施行後，術前から持続する膝蓋骨周囲の疼痛のため，5カ月で膝蓋骨の置換手術が行われた症例を経験した．症例は63歳の女性で，mid-vastus approachで膝蓋骨を置換せずTKAが行われた．術後，階段昇降，椅子から立ち上がるときなどの膝前面の痛みが続き，初回手術後5カ月で膝蓋骨の置換術を行った．再手術後右膝前面の疼痛は消失し，日常生活にほぼ支障はない．膝蓋骨置換の適応に関する明確な基準はない．整形外科医が共通した膝蓋骨置換の適応基準を持つことが望ましいと考えた．

　We report a case in which patellar resurfacing revision surgery was performed to treat persistent pre-patellar pain 5 months after total knee arthroplasty without patella resurfacing.　The patient was a 63-year-old woman who underwent total knee arthroplasty by a mid-vastus approach.　Postoperatively, she complained of persistence of the unbearable pre-patellar pain when she walked up and down stairs, or rose from a chair that she had experienced before the operation.　Patellar resurfacing surgery was performed and after the revision surgery she no longer experienced the pre-patellar pain and had no complaints in regard to daily living.　The indications and criteria for patella management, i. e., retaining or resurfacing, in total knee arthroplasty are unclear.　Although patients who require patellar resurfacing during total knee arthroplasty are rare, the issue should be discussed and resolved to avoid revision surgery as in our patient.