Patella resurfacing during total knee arthroplasty is cost-effective and has lower re-operation rates compared to non-resurfacing

Abstract

Background The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon’s preference, education, training, tradition and geographic location. Advocates for non-resurfacing or selectively resurfacing may claim no difference in patient reported outcomes, and that resurfacing is associated with increased risks such as extensor mechanism injury or malalignment, problems with the design of the patella component and technical issues intraoperatively. Aims To critically examine factors that should be considered in addition to patient reported outcomes in the decision process of resurfacing or non-resurfacing of the patella in total knee arthroplasty. Method A comprehensive literature search was conducted to identify factors that may influence decision making in addition to knee specific patient reported outcome measures such as surgical risks, patient quality of life, procedure cost, re-operation rate, implant design, surgeons learning curve and the fate of remaining cartilage in native patellae. Results Patient-reported outcomes are equivocal for resurfacing and non-resurfacing. Critical analysis of the available literature suggests that the complications of resurfacing the patella are historic, which is now lower with improved implant design and surgical technique. Routine resurfacing was cost-effective in the long term (potential saving £104 per case) and has lower rates of revision (absolute risk reduction 4%). Finally, surgical judgment in selective resurfacing was prone to errors. Conclusion Patella resurfacing and non-resurfacing had similar patient-reported outcomes. However, patella resurfacing was cost-effective and was associated with a lower rate of re-operation compared to non-resurfacing.

Resuperficialización de la rótula en el reemplazo primario total de rodilla: estudio comparativo a dos años de seguimiento

“…Diversos autores han descrito los beneficios de la resuperficialización de la rótula en los resultados funcionales y las tasas de revisión después de un RTR. 7,9,10 Quienes se oponen a este procedimiento justifican su conducta en las potenciales complicaciones asociadas a este paso adicional, como la inestabilidad, la fractura, el desgaste del polietileno, el pinzamiento de tejidos blandos y la osteólisis. 11,12 Por ejemplo, Schiavone Panni y cols.…”

“…informaron que la resuperficialización de la rótula se puede considerar una intervención costo-efectiva, y que tiene una baja tasa de revisión, aunque sus resultados funcionales son equivalentes entre pacientes sometidos a un RTR con resuperficialización y sin este procedimiento. 9 Por lo anterior, el objetivo de este estudio fue comparar los resultados funcionales del RTR con resuperficialización de la rótula o sin resuperficialización a los dos años de seguimiento.…”

Impact of patient and prosthesis characteristics on common reasons for total knee replacement revision: a registry study of 36,626 revision cases from Australia, Sweden, and USA

“…The strongest association between prosthesis factors and revision was shown in the analysis of patellar component use and revision for patellar reasons, where not using a patellar component showed much higher odds for revision for these diagnoses. Although some controversy may remain around function and pain relief regarding patellar component use ( 40 ), there seems less doubt that using a patellar component leads to a lower rate of revision for this reason ( 41 ). The finding that MB prostheses also showed higher odds for revision for patellar reasons is contrary to a study from the New Zealand Joint Registry that found fixed-bearing PS prostheses had a higher rate of secondary patellar resurfacing than mobile-bearing designs ( 42 ).…”

Patella Strength Characteristics in Cemented vs Press-fit Implants: A Biomechanical Analysis of Initial Stability

“…When indicated, patellar resurfacing has been documented to be cost-effective with a 4.6% reduction in the absolute risk of reoperation and a 13.85% reduction in the absolute risk of postoperative anterior knee pain in comparison to nonresurfacing [ [34] , [35] , [36] , [37] ]. Despite these benefits, patellar resurfacing has also been associated with complications including maltracking, implant loosening, dislocation, osteonecrosis, extensor mechanism injury, and fracture [ 38 , 39 ].…”