Patellar Resurfacing versus Nonresurfacing with Patellaplasty in Total Knee Arthroplasty

Background Anterior knee pain following total knee arthroplasty (TKA) remains one of the important reasons for patient dissatisfaction. The management of patellofemoral joint is controversial and a decision whether to resurface the patella or not, is important. The present study compares the clinical and radiological outcomes between patellar resurfacing and nonresurfacing in patients undergoing bilateral TKA Materials and Methods This is a prospective comparative study with 60 patients undergoing bilateral simultaneous TKA (120 knees) with posterior stabilized Hi flex fixed bearing knee (Zimmer, Warsaw, Indiana), by two surgeons. The patients were allocated to the two groups of resurfacing versus nonresurfacing of patella. In nonresurfacing group, patellaplasty was done. Patients with clinicoradiological signs of tricompartmental arthritis were included in the study. Exclusion criteria included unilateral TKA, rheumatoid arthritis, postseptic arthritis, previous high tibial osteotomy, or unicondylar knee arthroplasty cases. Patients were assessed using Knee Society Score (KSS), Modified Samsung Medical Centre Score (MSMCS), Feller patellar score. Radiological evaluation was performed at 1 year using congruence angle and patellar tilt angle Results Mean followup was 19 months (range 12–25 months). Mean KSS, MSMCS, Feller patellar scores in resurfacing group were 82.67, 10.68, and 25.97, respectively and in nonresurfacing group were 82.93, 10.48, and 24.90, respectively. Mean congruence angle in resurfacing group was −12.83° and in nonresurfacing group was −12.383° ( P = 0.917) and mean patellar tilt angle in resurfacing is 8.07 and nonresurfacing group is 7.97 ( P = 0.873) Conclusion There was no statistically significant difference in short-term clinical, functional, and radiological outcomes in the two groups and therefore, routine patellar resurfacing for patient undergoing TKA is not advantageous

[1]  S. Agarwala,et al.  Patellaplasty, as an Alternative to Replacing Patella in Total Knee Arthroplasty , 2015 .

[2]  S. Agarwala,et al.  Patellar clunk syndrome in a current high flexion total knee design. , 2013, The Journal of arthroplasty.

[3]  C. Ha,et al.  A novel patellofemoral scoring system for patellofemoral joint status. , 2013, The Journal of bone and joint surgery. American volume.

[4]  Z. Cai,et al.  Patellar resurfacing versus nonresurfacing in total knee arthroplasty: A meta-analysis of randomised controlled trials , 2013, International Orthopaedics.

[5]  B. Hwang,et al.  Comparison of patellar retention versus resurfacing in LCS mobile-bearing total knee arthroplasty , 2012, Knee Surgery, Sports Traumatology, Arthroscopy.

[6]  S. Moon,et al.  A Comparison of Patella Retention versus Resurfacing for Moderate or Severe Patellar Articular Defects in Total Knee Arthroplasty: Minimum 5-year Follow-up Results , 2011, Knee surgery & related research.

[7]  Ray Fitzpatrick,et al.  Patellar resurfacing in total knee replacement: five-year clinical and economic results of a large randomized controlled trial. , 2011, The Journal of bone and joint surgery. American volume.

[8]  George Pavlou,et al.  Patellar resurfacing in total knee arthroplasty: does design matter? A meta-analysis of 7075 cases. , 2011, The Journal of bone and joint surgery. American volume.

[9]  L. Dai,et al.  Is patellar resurfacing superior than nonresurfacing in total knee arthroplasty? A meta-analysis of randomized trials. , 2011, The Knee.

[10]  Jinmin Zhao,et al.  Systematic review of patellar resurfacing in total knee arthroplasty , 2011, International Orthopaedics.

[11]  K. Patel,et al.  Patella in total knee arthroplasty: to resurface or not to—a cohort study of staged bilateral total knee arthroplasty , 2011, International Orthopaedics.

[12]  Guangbin Wang,et al.  Patellar resurfacing in total knee arthroplasty for osteoarthritis: a meta-analysis , 2011, Knee Surgery, Sports Traumatology, Arthroscopy.

[13]  B. Bierbaum,et al.  Results of resurfacing a native patella in patients with a painful total knee arthroplasty. , 2010, The journal of knee surgery.

[14]  K. Takaoka,et al.  The incidence of the patellar clunk syndrome in a recently designed mobile-bearing posteriorly stabilised total knee replacement. , 2009, The Journal of bone and joint surgery. British volume.

[15]  Vittorio Calvisi,et al.  Resurfacing versus nonresurfacing the patella in total knee arthroplasty: a critical appraisal of the available evidence , 2009, Archives of Orthopaedic and Trauma Surgery.

[16]  R. Barrack,et al.  A Prospective Randomized Clinical Trial of Patellar Resurfacing and Nonresurfacing in Bilateral TKA , 2007, Clinical orthopaedics and related research.

[17]  I. Brenkel,et al.  Predicting pain after total knee arthroplasty. , 2006, The Journal of arthroplasty.

[18]  L. Wakefield,et al.  Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. , 2006, The Journal of bone and joint surgery. British volume.

[19]  T. Trikalinos,et al.  Patellar resurfacing in total knee arthroplasty. A meta-analysis. , 2005, The Journal of bone and joint surgery. American volume.

[20]  R. Porcher,et al.  A Meta-analysis of Patellar Replacement in Total Knee Arthroplasty , 2005, Clinical orthopaedics and related research.

[21]  M C Forster,et al.  Patellar resurfacing in total knee arthroplasty for osteoarthritis: a systematic review. , 2004, The Knee.

[22]  R. Burnett,et al.  Patella Resurfacing versus Nonresurfacing in Total Knee Arthroplasty: Results of a Randomized Controlled Clinical Trial at a Minimum of 10 Years’ Followup , 2004, Clinical orthopaedics and related research.

[23]  S David Stulberg,et al.  Predicting Total Knee Replacement Pain: A Prospective, Observational Study , 2003, Clinical orthopaedics and related research.

[24]  J. Rand Extensor mechanism complications following total knee arthroplasty. , 2003, The journal of knee surgery.

[25]  A. Khan,et al.  Secondary resurfacing of the patella for persistent anterior knee pain after primary knee arthroplasty. , 2003, The Journal of bone and joint surgery. British volume.

[26]  G. Bentley,et al.  Patellar Resurfacing in Total Knee Arthroplasty: A Prospective, Randomized Study , 2003, The Journal of bone and joint surgery. American volume.

[27]  M. Bulsara,et al.  Patellar Resurfacing in Total Knee Arthroplasty: A Prospective, Randomized Trial , 2002, The Journal of bone and joint surgery. American volume.

[28]  D. Ip,et al.  Comparison of two total knee prostheses on the incidence of patella clunk syndrome , 2002, International Orthopaedics.

[29]  R. Barrack,et al.  Component Rotation and Anterior Knee Pain After Total Knee Arthroplasty , 2001, Clinical orthopaedics and related research.

[30]  R. Barrack,et al.  Patellar Resurfacing in Total Knee Arthroplasty: A Prospective, Randomized, Double-Blind Study with Five to Seven Years of Follow-up , 2001, The Journal of bone and joint surgery. American volume.

[31]  P. Livesley,et al.  Should the patella be replaced in total knee replacement? , 2001, International Orthopaedics.

[32]  R. Barrack,et al.  Patellar Resurfacing in Total Knee Arthroplasty , 2000, The Journal of the American Academy of Orthopaedic Surgeons.

[33]  Michael Dunbar,et al.  Patient satisfaction after knee arthroplasty: A report on 27,372 knees operated on between 1981 and 1995 in Sweden , 2000, Acta orthopaedica Scandinavica.

[34]  R. Scott,et al.  Selective patellar nonresurfacing in total knee arthroplasty. 10 year results. , 1999, Clinical orthopaedics and related research.

[35]  H. Schroeder-Boersch,et al.  Advantages of patellar resurfacing in total knee arthroplasty , 1997, Archives of Orthopaedic and Trauma Surgery.

[36]  A. Rosenberg Management of the failed metal-backed patella. , 1996, Orthopedics.

[37]  J. Feller,et al.  Patellar resurfacing versus retention in total knee arthroplasty. , 1996, The Journal of bone and joint surgery. British volume.

[38]  R. Bourne,et al.  Resurfacing Versus Not Resurfacing the Patella During Total Knee Replacement , 1995, Clinical orthopaedics and related research.

[39]  S. Toksvig-Larsen,et al.  Roentgen stereophotogrammetric analysis as a predictor of mechanical loosening of knee prostheses. , 1995, The Journal of bone and joint surgery. British volume.

[40]  P. Keblish,et al.  Patellar resurfacing or retention in total knee arthroplasty. A prospective study of patients with bilateral replacements. , 1994, The Journal of bone and joint surgery. British volume.

[41]  R E Booth,et al.  The patellar "clunk" syndrome after posterior stabilized total knee arthroplasty. , 1994, Clinical orthopaedics and related research.

[42]  M. Freeman,et al.  Early migration of prostheses related to long-term survivorship. Comparison of tibial components in knee replacement. , 1992, The Journal of bone and joint surgery. British volume.

[43]  L. Dorr,et al.  Rationale of the Knee Society clinical rating system. , 1989, Clinical orthopaedics and related research.

[44]  S. Yoshino,et al.  Patellar replacement in bilateral total knee arthroplasty. A study of patients who had rheumatoid arthritis and no gross deformity of the patella. , 1989, The Journal of bone and joint surgery. American volume.

[45]  R. Balderston,et al.  The patellar clunk syndrome. A complication of posterior stabilized total knee arthroplasty. , 1989, Clinical orthopaedics and related research.

[46]  J E Bechtold,et al.  Patellar prosthesis positioning in total knee arthroplasty. A roentgenographic study. , 1988, Clinical orthopaedics and related research.

[47]  G. Scuderi**,et al.  Results after knee replacement with a posterior cruciate-substituting prosthesis. , 1988, The Journal of bone and joint surgery. American volume.

[48]  A H Burstein,et al.  The posterior stabilized condylar prosthesis: a modification of the total condylar design. Two to four-year clinical experience. , 1982, The Journal of bone and joint surgery. American volume.

[49]  C. Ranawat,et al.  Duo-condylar knee arthroplasty: hospital for special surgery design. , 1976, Clinical orthopaedics and related research.

[50]  C. Ranawat,et al.  A comparison of four models of total knee-replacement prostheses. , 1976, The Journal of bone and joint surgery. American volume.

[51]  C. Ertürk,et al.  Patelloplasty with patellar decompression to relieve anterior knee pain in total knee arthroplasty. , 2011, Acta orthopaedica et traumatologica turcica.

[52]  D. Berry,et al.  Isolated patellar component revision of total knee arthroplasty. , 1993, Clinical orthopaedics and related research.