Maltracking Patella, Pseudo Patella Baja, dan Patellar Tilt sebagai faktor risiko terjadinya nyeri patellofemoral pasca total knee arthroplasty tanpa mengganti komponen patella di RSUP Sanglah, Bali, Indonesia

Gusti Ngurah Putra Stanu; Putu Astawa; I Wayan Suryanto Dusak; Elysanti Dwi Martadiani; I Gede Eka Wiratnaya; I Gusti Ngurah Wien Aryana

doi:10.15562/ism.v11i3.782

Maltracking Patella, Pseudo Patella Baja, dan Patellar Tilt sebagai faktor risiko terjadinya nyeri patellofemoral pasca total knee arthroplasty tanpa mengganti komponen patella di RSUP Sanglah, Bali, Indonesia

Gusti Ngurah Putra Stanu ,

Putu Astawa ,

I Wayan Suryanto Dusak ,

Elysanti Dwi Martadiani ,

I Gede Eka Wiratnaya ,

I Gusti Ngurah Wien Aryana ,

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DOI: https://doi.org/10.15562/ism.v11i3.782 |
Published: 2020-12-01

Abstract

Background: Total Knee Artrhoplasty (TKA) is the final therapeutic choice for osteoarthritis (OA) if conservative therapy fails. However, some studies show that about 50% of patients undergoing TKA complain on anterior knee pain postoperatively. One of the most common causes of knee pain comes from the patellofemoral components. Some interesting potential risk factors needing investigations include patellar maltracking, pseudo patella baja, and patellar tilt. By knowing the relationship between these potential risk factors and patellofemoral pain after TKA, it is hoped that further modifications can be made intraoperatively to maximalize the functional outcomes of these patients.

Methods: This is a Case Control study to investigate the factors affecting patellofemoral pain after TKA without patellar resurfacing, including patellar maltracking, pseudopatella baja, and patellar tilt, compared to those who don’t experience patellofemoral pain. The study was conducted at Sanglah Hospital, Denpasar, Bali in September-December 2019. Clinical and radiographic data were obtained secondarily from patient medical records.

Results: Chi Square Test for Maltracking patella test showed a value of P = 0,000 (P <0.05), indicating a significant difference between the group with patellofemoral pain and those without. Chi Square Test for Pseudopatella Baja showed a value of P = 1,000 (P> 0.05), indicating no significant difference. While the Chi Square Test for Patellar Tilt showed a value of P = 0.045 (P <0.05), indicating a significant difference.

Conclusion: Patellar maltracking and patellar tilt are proven to be risk factors for higher NRS values compared to those without, in post-TKA patients patellar resurfacing. Whereas Pseudopatella Baja was not proven to be a risk factor for higher NRS values.

Latar Belakang: Total Knee Artrhoplasty (TKA) merupakan pilihan terapi tahap akhir dari osteoartritis (OA) lutut bila manajemen konservatif gagal. Walaupun demikian, beberapa studi menunjukan bahwa pasca operasi TKA, sekitar 50% pasien justru mengeluhkan nyeri pada bagian depan lutut. Salah satu penyebab tersering nyeri lutut pada pasien-pasien OA pasca TKA berasal dari komponen patellofemoral. Beberapa faktor risiko yang menarik untuk diteliti sebagai peyebab nyeri patellofemoral pasca TKA antara lain maltracking patella, pseudo patella baja, dan patellar tilt. Dengan mengetahui keterkaitan antara faktor-faktor risiko potensial tersebut dengan nyeri patellofemoral pasca TKA, diharapkan lebih lanjut dapat dilakukan modifikasi saat operasi guna mengurangi insiden nyeri patellofemoral pada pasien-pasien pasca TKA, sehingga dapat meningkatkan keluaran fungsional pasien-pasien tersebut.

Metode: Penelitian ini merupakan penelitian Case Control untuk mengetahui faktor risiko terjadinya nyeri patellofemoral pasca TKA tanpa mengganti komponen patella pasien-pasien dengan OA lutut, terkait dengan yang memiliki faktor maltracking patella, pseudopatella baja, dan patellar tilt, dibandingkan dengan yang tidak memiliki faktor tersebut. Penelitian dilakukan di RSUP Sanglah, Denpasar, Bali selama bulan September-Desember 2019. Data klinis dan radiografis didapat dari data sekunder dari rekam medis penderita.

Hasil: Uji Chi Square Maltracking patella menunjukkan nilai P = 0,000 ( P < 0,05), menandakan perbedaan yang signifikan antara kelompok yang nyeri dan tidak nyeri. Uji Chi Square Pseudopatella Baja menunjukkan nilai P = 1,000 ( P > 0,05), menandakan tidak adanya perbedaan yang signifikan. Sedangkan Uji Chi-square Patellar Tilt menunjukkan nilai P = 0,045 ( P < 0,05), menandakan perbedaan yang signifikan.

Simpulan: Maltracking patella dan patellar tilt merupakan faktor risiko terhadap nilai NRS yang lebih tinggi dibandingkan tanpa maltracking patella pada pasien-pasien pasca-TKA tanpa mengganti komponen patella. Sedangkan Pseudopatella Baja tidak terbukti sebagai faktor risiko terhadap nilai NRS yang lebih tinggi dibandingkan tanpa pseudopatella Baja pada pasien-pasien pasca-TKA tanpa mengganti komponen patella.

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