- Discussion:
- controversy regarding patella resurfacing has swung toward resurfacing in most cases (and all rheumatoids);
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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
A. J. Smith 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:
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Patellar Resurfacing in TKA. A Prospective, Randomized, Double-Blind Study with Five to Seven Years of Follow-up. Barrack JBJS (2001)
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Total knee arthroplasty without patellar resurfacing.
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The patellofemoral joint after total knee arthroplasty without patellar resurfacing.
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Total knee arthroplasty without patellar resurfacing. Clinical outcomes and long-term follow-up evaluation.
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The consequences of not resurfacing the patella.
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Long-term changes of the nonresurfaced patella after total knee arthroplasty.
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Orthopaedic crossfire--All patellae should be resurfaced during primary total knee arthroplasty: in opposition.
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Failure to resurface the patella during total knee arthroplasty may result in more knee pain and secondary surgery.
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Retention of the patella in total knee arthroplasty for rheumatoid arthritis.
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Total knee arthroplasty without patellar resurfacing.
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Patellar resurfacing in total knee arthroplasty. A meta-analysis.
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Long-term clinical results and radiographic changes in the nonresurfaced patella after TKR: 78 knees followed for mean 12 years.
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Total knee replacement with and without patellar resurfacing
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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 David J. Wood 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:
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Resurfacing of the patella in TKR. A prospective, randomized, double blind study. RL Barrack MD et al. JBJS. Vol 79-A. No 8. Aug. 1997. p 1121.
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Orthopaedic crossfire--All patellae should be resurfaced during primary total knee arthroplasty: in the affirmative.
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Patellar resurfacing in total knee arthroplasty. A prospective, randomized study.
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Patellar resurfacing in total knee arthroplasty: a prospective, randomized trial.
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Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial.
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Clinical evaluation of resurfacing of the patella in posterior-stabilizing total knee replacement.
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Patella resurfacing: no benefit for the long-term outcome of total knee arthroplasty. A 10- to 16.3-year follow-up.
Patellar Resurfacing in Total Knee Arthroplasty. A Prospective, Randomized Study
Should the patella be resurfaced in total knee arthroplasty Efficacy of patellar resurfacing.
Resurfacing versus not resurfacing the patella during total knee replacement.
Long term complications after total knee arthroplasty with or without resurfacing of the patella. AD Boyd et al. JBJS. Vol 75-A. 1993. p 674-681.
Patella resurfacing versus nonresurfacing in TKR: results of a randomized controlled clinical trial at a minimum of 10 years' followup.
Resurfacing versus not resurfacing the patella in total knee arthroplasty: 8- to 10-year results.
Should we resurface the patella in total knee replacement? Experience with the Nex Gen prothesis.
A Prospective Randomized Clinical Trial of Patellar Resurfacing and Nonresurfacing in Bilateral TKA.
