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Wheeless' Textbook of Orthopaedics

Indications for Patellar Resurfacing

- See: Patella in TKR Menu


- TKR w/o resurfacing:
      - less than 20 mm of patella thickness is a relative contraindication for patellar resurfacing; 
      - if unsure as to whether or not resurfacing will be performed, then use a TKR design which specifically will accomodate unresurfaced patella; 
      - in report by Barrack, et al, authors sought to determine parameters were predictive of the clinical result following TKR w/ or w/o patellar resurfacing; 
                 - 86 patients (118 knees) undergoing TKR for the treatment of osteoarthritis were enrolled in a prospective, randomized, double-blind study; 
                  - 67 patients (ninety-three knees) were followed for a minimum of five years (range, sixty to 84 months; average, 70.5 months); 
                  - with numbers available, there was no significant difference between groups treated with and w/o resurfacing with regard to overall Knee Society score or the pain and function subscores; 
      - in the study by Smith AJ, et al, there was no benefit to patellar resurfacing;
             - in 22/73 knees (30.1%) with and 18/86 knees (20.9%) without patellar resurfacing there was some degree of anterior knee pain (p = 0.183);
             - a significant association between knee flexion contracture and anterior knee pain was observed in those knees with patellar resurfacing (p = 0.006). 
      - references supporting selective approach to resurfacing:
                - Total knee arthroplasty without patellar resurfacing
                - Total knee replacement with and without patellar resurfacing: a prospective, randomised trial using the profix total knee system.
                - The patellofemoral joint after total knee arthroplasty without patellar resurfacing.
                - Total knee arthroplasty without patellar resurfacing. Clinical outcomes and long-term follow-up evaluation
                - Long-term changes of the nonresurfaced patella after total knee arthroplasty. 
                - Orthopaedic crossfire--All patellae should be resurfaced during primary total knee arthroplasty: in opposition.
                - Failure to resurface the patella during total knee arthroplasty may result in more knee pain and secondary surgery. 
                - Retention of the patella in total knee arthroplasty for rheumatoid arthritis. 
                - Patellar resurfacing in total knee arthroplasty. A meta-analysis. 
                - Patellar Resurfacing in Total Knee Arthroplasty: Does Design Matter?: A Meta-Analysis of 7075 Cases
                - To resurface the patella or not? Better assessments needed to address the benefits for total knee replacement: commentary on an article by George Pavlou, BSc, MRCS, et al.: "Patellar resurfacing in total knee arthroplasty: does design matter? A meta-analysis of 7075 cases".
        - references supporting non-resurfacing:
                - A Prospective Randomized Clinical Trial of Patellar Resurfacing and Nonresurfacing in Bilateral TKA.
                - Orthopaedic crossfire--All patellae should be resurfaced during primary total knee arthroplasty: in opposition.
                - Component rotation and anterior knee pain after total knee arthroplasty.
                - Patellar resurfacing in total knee arthroplasty. A prospective, randomized, double-blind study with five to seven years of follow-up. 
                - Total knee replacement with and without patellar resurfacing: a prospective, randomised trial using the profix total knee system.
                - Long-term clinical results and radiographic changes in the nonresurfaced patella after total knee arthroplasty: 78 knees followed for mean 12 years. 
                - Total knee arthroplasty without patellar resurfacing. 
                - The consequences of not resurfacing the patella. 
                - Patella resurfacing: no benefit for the long-term outcome of total knee arthroplasty. A 10- to 16.3-year follow-up. 
                - Does patella resurfacing really matter? Pain and function in 972 patients after primary total knee arthroplasty.
                - Resurfacing of the patella in total knee arthroplasty. A prospective, randomized, double-blind study. 
                - Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. 
                - Resurfacing versus not resurfacing the patella in total knee arthroplasty: 8- to 10-year results. 
                - Patella resurfacing versus nonresurfacing in total knee arthroplasty: results of a randomized controlled clinical trial at a minimum of 10 years' followup. 
                - Resurfacing versus not resurfacing the patella during total knee replacement
                - Should the patella be resurfaced in total knee arthroplasty? Efficacy of patellar resurfacing. 
                - Patellar resurfacing vs non resurfacing during primar TKR - a review of the literature.
                - Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. 
                - Patella Resurfacing in TKA
                - Assessment of the damage in retrieved patellar components
                - Patellar resurfacing in total knee replacement: five-year clinical and economic results of a large randomized controlled trial.
                - Is Further Treatment Necessary for Patellar Crepitus After Total Knee Arthroplasty?


- TKR w/ resurfacing
       - most surgeons presently advocate resurfacing for all patients undergoing TKR; 
       - resurfacing leads to less patellofemoral pain and better stair climbing; 
       - as noted by Barrack, et al (1997), 10 % of 60 patients that did not have patellar resurfacing experienced anterior knee pain that was severe enough to warrant subsequent resurfacing; 
       - in the report by Wood DJ, et al, the authors aimed to identify differences in the clinical outcome of TKR according to whether or not patellar resurfacing had been performed in a prospective, randomized study of 220 osteoarthritic knees. 
                  - 12% of the 128 knees without patellar resurfacing and 10% of the ninety-two knees with patellar resurfacing underwent a revision or another type of reoperation related to the patellofemoral articulation; 
                   - this difference was not significant (chi square with one degree of freedom = 0.206, p = 0.650). 
                   - at time of latest follow-up, there was a significantly higher incidence of anterior pain (p = 0.016) in knees that had not had patellar resurfacing; 
       - references supporting resufacing:
               -
Resurfacing of the patella in total knee arthroplasty. A prospective, randomized, double-blind study.
               - Patellar resurfacing in total knee arthroplasty: a prospective, randomized trial.
               - Orthopaedic crossfire--All patellae should be resurfaced during primary total knee arthroplasty: in the affirmative. 
               - Patellar resurfacing in total knee arthroplasty. A prospective, randomized study. 
               - Clinical evaluation of resurfacing of the patella in posterior-stabilizing total knee replacement.
               - Early outcomes of patella resurfacing in total knee arthroplasty
               - Should we resurface the patella in total knee replacement? Experience with the Nex Gen prothesis. 
               - Surface damage of patellar components used in total knee arthroplasty



Long-term complications after total knee arthroplasty with or without resurfacing of the patella.

Patella Resurfacing in TKA



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, January 2, 2013 2:53 pm