Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?

Kremers, Hilal Maradit; Haque, Omar; Kremers, Walter K.; Berry, Daniel J.; Lewallen, David G.; Trousdale, Robert T.; Sierra, Rafael J.

doi:10.1016/j.arth.2016.10.014

Cited by 30 publications

(18 citation statements)

References 26 publications

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“…Advantages of patellar resurfacing include a lower reoperation rate because of less knee pain after surgery and better 2-year postoperative Knee Society clinical scores [41][42][43] ; however, disadvantages include fracture, hardware failure, and revision difficulty. 44 Spencer et al 12 retrospectively compared the outcomes of 169 TKA procedures in 110 patients with circumferential patellar denervation (83 TKA) versus patellar resurfacing (86 TKA). At a minimum of 2 years of follow-up, they found no difference in overall functional outcomes between the two groups, and both groups had nearly identical Clinical Knee Rating System kneeling scores (2.7 resurfacing vs. 2.6 denervation).…”

Section: Patellar Resurfacing Versus Nonresurfacingmentioning

confidence: 99%

Kneeling after Total Knee Arthroplasty

2019

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The ability to kneel is one of the many patient goals after total knee arthroplasty (TKA). Few studies have addressed patients' ability to kneel after TKA as a primary outcome. Given the altered biomechanics of the knee after TKA, the various implant designs, and multiple surgical approaches, there is a need to further understand the patient's kneeling ability after TKA. We evaluated the available literature on this topic to help to guide postoperative care recommendations. Biomechanical data show that the load borne by the patellofemoral joint is elevated significantly at all flexion angles, whereas tibiofemoral articulation pressures are elevated only at 90 to 120 degrees of flexion. However, these increased pressures are rarely borne by prosthetic knees because patients often avoid kneeling after TKA. In patients who do kneel after surgery, data show that increased range of motion promotes improved kneeling performance. Targeted interventions to encourage kneeling after TKA, including preoperative education, have not shown an ability to increase the frequency with which patients kneel after TKA. Reasons for patient avoidance of kneeling are multifaceted and complex. There is no biomechanical or clinical evidence contraindicating kneeling after TKA. There are insufficient data to recommend particular prosthetic designs or surgical approaches to maximize kneeling ability after surgery. Musculoskeletal health care providers should continue to promote kneeling to allow patients to achieve maximum clinical benefit after TKA.

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Section: Patellar Resurfacing Versus Nonresurfacingmentioning

confidence: 99%

Kneeling after Total Knee Arthroplasty

2019

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“…A cost-effectiveness analysis demonstrated the superiority of resurfacing over retention of the patella [20]. On the other hand, selectively not resurfacing the patella appeared to yield similar results compared with routine resurfacing [21]. The main feature of the modern prosthesis is the modification of the femoral component, which includes a deeper and more extensive femoral trochlear groove and a smoother intercondylar box transition zone.…”

Section: Discussionmentioning

confidence: 99%

Influence of femoral implant design modification on anterior knee pain and patellar crepitus in patients who underwent total knee arthroplasty without patella resurfacing

Huang

Gao

Ding

et al. 2020

Preprint

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Background : The incidence of patient dissatisfaction due to multiple factors, especially anterior knee pain (AKP) and patellar crepitus after total knee arthroplasty (TKA), remain a concern. Improvements in the femoral component of the traditional prosthesis could reduce the incidence of these complications in TKA performed with patellar resurfacing. This study aimed to explore whether TKA without patellar resurfacing benefits from this modification in femoral implant design with regard to AKP and patellar crepitus. Methods : Sixty-two patients (85 knees) who underwent TKA with the modern prosthesis and 62 age- and sex-matched patients (90 knees) fitted with the traditional prosthesis were enrolled in this study. The incidence of AKP and patellar crepitus, and Knee Society Score (KSS) was recorded. Statistical analyses were performed to determine whether there were differences between the groups. Results: The incidence of AKP was significantly lower in the study group compared with the control group at the 3-month and 1-year follow-ups (4.7% vs. 13.3% [ p =0.048] and 3.5% vs. 13.3% [ p =0.021], respectively). The incidence of patellar crepitus was significantly lower in the study group compared with the control group at the 3-month and 1-year follow-ups (15.3% vs. 34.4% [ p =0.004] and 10.6% vs. 28.9% [ p =0.002], respectively). There was no significant difference in KSS between the groups. Conclusion : Results revealed that TKA without patellar resurfacing benefited from the femoral implant design modification with regard to AKP and patellar crepitus. These data may be meaningful to surgeons who use the modern prosthesis and omit resurfacing the patella in their patients. Keywords : total knee arthroplasty, femoral component, prosthesis design, anterior knee pain, patellar crepitus

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“…A cost-effectiveness analysis demonstrated the superiority of resurfacing over retention of the patella [20]. On the other hand, selectively not resurfacing the patella appears to yield similar results compared with routine resurfacing [21]. The main feature of the modern prosthesis is the modification of the femoral component, which includes a deeper and more extensive femoral trochlear groove and a smoother intercondylar box transition zone.…”

Section: Discussionmentioning

confidence: 99%

Influence of femoral implant design modification on anterior knee pain and patellar crepitus in patients who underwent total knee arthroplasty without patella resurfacing

Huang

Gao

Ding

et al. 2020

BMC Musculoskelet Disord

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Background: The incidence of patient dissatisfaction due to anterior knee pain (AKP) and patellar crepitus after total knee arthroplasty (TKA) remains a concern. However, it has been shown that improvements in the femoral component of traditional prostheses could reduce these instances of pain in the case of TKA performed with patellar resurfacing. This study aims to investigate whether TKA without patellar resurfacing can also benefit from the aforementioned femoral component modification in reducing AKP and patellar crepitus post-TKA. Methods: Sixty-two patients (85 knees) who underwent TKA using the modern prosthesis and 62 age-and sexmatched patients (90 knees) fitted with the traditional prosthesis were enrolled in this study. The occurrence of AKP and patellar crepitus as well as the Knee Society Score (KSS) were consequently recorded, and the data was analyzed in order to determine whether there was a statistically significant difference between the two groups. Results: The incidence of AKP was significantly lower in the study group compared with the control group at the 3-month and 1-year follow-ups (4.7% vs. 13.3% [p = 0.048] and 3.5% vs. 13.3% [p = 0.021], respectively). In addition, the incidence of patellar crepitus was also significantly lower in the study group compared with the control group at the 3-month and 1-year follow-ups (15.3% vs. 34.4% [p = 0.004] and 10.6% vs. 28.9% [p = 0.002], respectively). There was no significant difference in the KSS between the two groups. Conclusions: These results revealed that TKA without patellar resurfacing will indeed benefit from the modified femoral implant design in reducing AKP and patellar crepitus, a finding that may be beneficial to surgeons who select implants for their patients when patellar resurfacing is not planned or not possible due to other reasons.

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Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?

Cited by 30 publications

References 26 publications

Kneeling after Total Knee Arthroplasty

Kneeling after Total Knee Arthroplasty

Influence of femoral implant design modification on anterior knee pain and patellar crepitus in patients who underwent total knee arthroplasty without patella resurfacing

Influence of femoral implant design modification on anterior knee pain and patellar crepitus in patients who underwent total knee arthroplasty without patella resurfacing

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