Early outcomes of patella resurfacing in total knee arthroplasty

Abstract

BackgroundPatella resurfacing in total knee arthroplasty is a contentious issue. The literature suggests that resurfacing of the patella is based on surgeon preference, and little is known about the role and timing of resurfacing and how this affects outcomes.MethodsWe analyzed 134,799 total knee arthroplasties using data from the Australian Orthopaedic Association National Joint Replacement Registry. Hazards ratios (HRs) were used to compare rates of early revision between patella resurfacing at the primary procedure (the resurfacing group, R) and primary arthroplasty without resurfacing (no-resurfacing group, NR). We also analyzed the outcomes of NR that were revised for isolated patella addition.ResultsAt 5 years, the R group showed a lower revision rate than the NR group: cumulative per cent revision (CPR) 3.1% and 4.0%, respectively (HR = 0.75, p < 0.001). Revisions for patellofemoral pain were more common in the NR group (17%) than in the R group (1%), and “patella only” revisions were more common in the NR group (29%) than in the R group (6%). Non-resurfaced knees revised for isolated patella addition had a higher revision rate than patella resurfacing at the primary procedure, with a 4-year CPR of 15% and 2.8%, respectively (HR = 4.1, p < 0.001).InterpretationRates of early revision of primary total knees were higher when the patella was not resurfaced, and suggest that surgeons may be inclined to resurface later if there is patellofemoral pain. However, 15% of non-resurfaced knees revised for patella addition are re-revised by 4 years. Our results suggest an early beneficial outcome for patella resurfacing at primary arthroplasty based on revision rates up to 5 years.

Revision Surgery for Patellofemoral Problems: Should We Always Resurface?

“…Fourth, an implant registry could not account for varying indications for revision surgery among surgeons or acceptance by patients. We acknowledge surgeons may be more inclined to offer a patient undergoing a BKA a patella-only revision to a TKA for anterior knee pain or even unexplained pain, artificially increasing the BKA revision rate [10], but we had no way to control for these variables. Finally, formulating firm conclusions on the benefit of revision surgery as gauged by the number of rerevisions (a total of three surgeries including the index operation) was problematic given the small numbers involved-two from the initial BKA group and six from the initial TKA group.…”

“…Our registry data showed routine patellar resurfacing resulted in a lower TKA CRR compared to BKA, consistent with the meta-analyses and other registry studies. Clements et al [10] had the largest registry study on this topic to date, analyzing 134,799 knee arthroplasties from the Australian Orthopaedic Association National Joint Replacement Registry and comparing the CRR between TKA and BKA. At 5 years, the BKA group had a 1.33 times higher risk of revision than the TKA group, with revisions for patellofemoral pain being more common in the BKA group.…”

“…A 2009 poll of American Association of Hip and Knee Surgeons found 76% of members resurface ''virtually all'' of their TKA cases, 16% resurface more than 90% of the time, and only 5% resurface fewer than 10% of their TKA cases [2]. While North American surgeons traditionally resurface the patella, the same is not true elsewhere; the registries of Norway and Sweden indicate resurfacing occurs less than 11% and 14% of the time, respectively [25]; the Australian registry notes a rate of 43% [10]; and Denmark's registry records a 76% rate of resurfacing in primary knee arthroplasty [25]. Thus, there does not appear to be agreement on whether to routinely resurface the patella and whether resurfacing or not results in better implant survival.…”

“…Nevertheless, with pooled data, nearly all of the recent metaanalyses favor resurfacing [3,13,[21][22][23], the minority opinion being there is no difference [8]. While data from a registry study were included [26] in a recent meta-analysis [3], dedicated registry studies were decidedly rarer, with one study [15] focusing on problems common to both TKAs and BKAs and another suggesting lower revision rates in patients having TKA [10]. A 2009 poll of American Association of Hip and Knee Surgeons found 76% of members resurface ''virtually all'' of their TKA cases, 16% resurface more than 90% of the time, and only 5% resurface fewer than 10% of their TKA cases [2].…”

Native Patella Retention Versus Resurfacing in a Cohort of Staged Bilateral Total Knee Patients

“…While some studies and meta-analysis have shown patella resurfacing to be better in terms of cost-effectiveness, reduced revision rate for anterior knee pain, and produced less anterior knee pain, emerging evidence suggests that resurfacing has no influence on the clinical outcome of the patient. [12][13][14][15][16][17] Proponents of retention of the native patella claim that it has no affect on total healthcare cost, reoperation rate or functional outcome and has a lower complication rate. [18][19][20][21] TKA is one of the most commonly performed operations in adult reconstructive surgery and there currently exists three different approaches among orthopedic surgeons regarding patellar resurfacing: resurfacing all patellae, not resurfacing all patellae, and selective resurfacing for patients with significant pre-operative patellofemoral arthritis-related symptoms and/or advanced patellofemoral arthritis on radiographs.…”