Functional Outcomes Following Total Knee Arthroplasty Without Patellar Resurfacing: A Minimum Two-Year Follow-Up Retrospective Cohort Study

Li, Daniel; Bi, Andrew S; Samra, Sahej; Samra, Nehal S; Wu, Decheng; Ma, Yuangzheng

doi:10.7759/cureus.16036

Cited by 4 publications

(1 citation statement)

References 28 publications

(32 reference statements)

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“…In our study, the mean follow-up was 18 months, which is close to that of other series [ 6 ], and the indication for surgery was gonarthrosis, which is identical in all series. Concerning the mean age, we notice a concordance between our series and most series [ 7 - 8 ]. The high prevalence of gonarthrosis in this elderly population is related to the fact that advanced age is an important etiological factor in gonarthrosis [ 2 ].…”

Section: Discussionsupporting

confidence: 89%

Resurfacing Versus Non-resurfacing Patella in Total Knee Replacement: When and What to Choose

Samih,

Fadili,

Chagou

et al. 2023

Cureus

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Introduction: The opinion on the necessity of patella resurfacing has been deeply divided in the scientific community. There are three approaches to the management of the patella in total knee arthroplasty (TKA). The first method involves always resurfacing the patella, the second method involves never resurfacing it, and the third method involves resurfacing the patella only under specific circumstances. Different data support each of these strategies, but no consensus on the best management has been reached. Methods: This is a retrospective study of 106 cases of TKA (including 29 resurfaced patellas and 77 non-resurfaced patellas), over 5 years, at the Trauma-Orthopedics Department of the Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, Morocco. Our objective is to conduct a comparative study between TKA with patella resurfacing and those without resurfacing, by analyzing the functional and radiological results obtained after the operation, to show each technique's advantages and disadvantages. Results: The average age of our patients was 65 years with extremes ranging from 46 to 80 years. There was a clear female predominance with a sex ratio of 0.2. The left side was predominantly affected. Primary gonarthrosis was the main diagnosis. Our results showed no significant difference between the two groups in terms of patient satisfaction and Knee Society Score (KSS). Nevertheless, complications generated by resurfacing, such as infection, anterior pain, stiffness, and loosening of the patellar component, as well as additional costs and increased operative time, were observed. In the majority of meta-analyses, there was no discernible difference in clinical and functional results between the resurfaced and non-resurfaced groups, suggesting that patellar resurfacing is not beneficial and, therefore, unnecessary. Conclusion: It appears that regular resurfacing is not necessary. However, there is agreement that resurfacing the patella is the best course of action for patients with inflammatory arthropathy, considerable patella malalignment, and severe patellofemoral osteoarthritis. There are arguments in favor of each of the patella resurfacing techniques, but none of them are particularly compelling, each of these strategies has its advantages and should not be considered bad. The final decision, therefore, rests on each surgeon's practice, training, and experience.

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Section: Discussionsupporting

confidence: 89%

Resurfacing Versus Non-resurfacing Patella in Total Knee Replacement: When and What to Choose

Samih,

Fadili,

Chagou

et al. 2023

Cureus

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HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment – A prospective randomized and multicenter study

Chen

Wang

et al. 2022

Journal of Orthopaedic Translation

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Effect of patellofemoral joint overstuffing following total knee arthroplasty without patella resurfacing on clinical efficacy and related factors analysis

Wang,

Zhang,

Wei

2024

J Orthop Surg Res

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Objective To analyze the influencing factors for patellofemoral joint (PFJ) overstuffing following total knee arthroplasty (TKA) without patella resurfacing, and explore the effect of PFJ overstuffing on clinical efficacy. Methods A retrospective analysis was conducted on 168 patients with end-stage knee osteoarthritis who underwent TKA without patella resurfacing at our hospital between Match 2019 and September 2021. The clinical data of these patients were retrospectively analyzed. In this study, PFJ overstuffing was defined as a postoperative PFJ distance greater than 1 mm compared to the preoperative measurement. The occurrence of postoperative PFJ overstuffing was counted. The patients were divided into the overstuffing group (n = 109) and the non-overstuffing group (n = 59) to count the patellar thickness and thickness of femoral anterior condyle in all patients before and after surgery, and analyze the influencing factors for postoperative PFJ overstuffing in such patients. Patients were followed up for 2 years to compare the recovery time of postoperative pain, score of visual analogue scale (VAS) and flexion activity between the two groups. Results There was no significant difference in patellar thickness between preoperative and postoperative measurements of the patients (P > 0.05). However, the thickness of the femoral anterior condyle and the PFJ distance after surgery increased significantly compared with those before surgery (P < 0.05). Among the 168 patients, 109 cases (64.88%) experienced PFJ overstuffing. The risk of PFJ overstuffing was higher in female patients than in male (P < 0.05). The preoperative thickness of the femoral anterior condyle in the overstuffing group was significantly smaller compared to the non-overstuffing group (P < 0.001). Compared with the non-overstuffing group, the overstuffing group had longer recovery time of postoperative pain (P < 0.05), and had lower flexion activity at 2 years after surgery (P < 0.001). However, no significant difference was found in VAS score between the overstuffing group and the non-overstuffing group at 2 years after surgery (P > 0.05). Spearman rank correlation analysis indicated females tend to have a lower preoperative thickness of the femoral anterior condyle (r=-0.424, P < 0.001), as well as a positive postoperative PFJ overstuffing (r = 0.237, P < 0.05). Furthermore, there was a negative correlation between preoperative thickness of the femoral anterior condyle and postoperative PFJ overstuffing (r=-0.540, P < 0.001). Conclusion Following TKA without patella resurfacing, there is a high risk of PFJ overstuffing, particularly among female patients and those with a small thickness of the femoral anterior condyle. Therefore, special attention should be given to these high-risk groups during clinical treatment.

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Functional Outcomes Following Total Knee Arthroplasty Without Patellar Resurfacing: A Minimum Two-Year Follow-Up Retrospective Cohort Study

Cited by 4 publications

References 28 publications

Resurfacing Versus Non-resurfacing Patella in Total Knee Replacement: When and What to Choose

Resurfacing Versus Non-resurfacing Patella in Total Knee Replacement: When and What to Choose

HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment – A prospective randomized and multicenter study

Effect of patellofemoral joint overstuffing following total knee arthroplasty without patella resurfacing on clinical efficacy and related factors analysis

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