Patella retention versus replacement in total knee arthroplasty; functional and clinimetric aspects

Hemert, Wouter L.W. van; Senden, Rachel; Grimm, Bernd; Kester, A.D.M.; Linde, Matthijs J. A. van der; Heyligers, Ide C.

doi:10.1007/s00402-008-0640-8

Cited by 28 publications

(30 citation statements)

References 29 publications

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“…Anterior knee pain was the most common complication in the non-resurfaced groups. These results have been supported by other literature suggesting resurfacing of the patella leads to lower rates of revision (Forster 2004, Pakos et al 2005, O'Shea et al 2006, Garneti et al 2008) or increased patient satisfaction (Schroeder-Boersch et al 1998, Mayman et al 2003, Waters and Bentley 2003, Burnett et al 2004, Gildone et al 2005, Parvizi et al 2005, Berti et al 2006, van Hemert et al 2009). Despite promising results, other studies have suggested that resurfacing of the patella does not change rates of revision, patient satisfaction, or clinical outcome (Grace and Sim 1988, Healy et al 1995, Robertsson et al 2000, Wood et al 2002, 2005, Burnett et al 2004, 2007, Campbell et al 2006, Myles et al 2006, Oztürk et al 2006, Smith et al 2006, 2008, Epinette and Manley 2008).…”

Section: Introductionsupporting

confidence: 76%

Early outcomes of patella resurfacing in total knee arthroplasty

Clements¹,

Miller²,

Whitehouse³

et al. 2009

Acta Orthopaedica

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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.

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Section: Introductionsupporting

confidence: 76%

Early outcomes of patella resurfacing in total knee arthroplasty

Clements¹,

Miller²,

Whitehouse³

et al. 2009

Acta Orthopaedica

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“…If more objective assessment tools are used, impalpable differences between resurfacing and nonresurfacing might be found. In a recent study, Hemert et al [5] used the Dynaport knee test and the Minimod gait test to assess the function of the knee after TKA. The Dynaport knee test showed a significant functional advantage for patients with a resurfaced patella, while knee society score (KSS) did not.…”

Section: Introductionmentioning

confidence: 99%

“…Ever since patella resurfacing was introduced, research and discussion on resurfacing patella were increasing. Recent meta-analysis or evidence-based analysis has reached a consensus [1][2][3][4] , although there is a tendency to resurface the patella in patients with inflammatory arthritis [5] , whether the patella should be resurfaced for the primary TKA is still controversial for the time being.…”

Section: Introductionmentioning

confidence: 99%

Gait analysis in primary total knee arthroplasty with and without patellar resurfacing: A randomized control study

Bai

Zhou

et al. 2010

J. Shanghai Jiaotong Univ. (Sci.)

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It is still controversial whether or not to resurface patella during primary total knee arthroplasty (TKA). One of the reasons may be insensitive measurement tools. We conducted a randomized controlled study to compare kinematic and kinetic parameters of resurfacing and nonresurfacing patella with the Vicon gait analysis system. The results show that patient post-operative gait of the two groups improved compared to pre-operative gait. Part of gait parameters, knee flexion at heel-strike, double limb support time and maximum adduction angle appeared to be statistically difference in 3 months, but 12 months later, the gait parameters of the two groups had no significant difference. Therefore, it seems that the final function of knee after TKA is not related whether or not to resurface patella.

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“…Also, knee scores may not capture existing differences equally [37]. Moreover, the subvastus approach might not result in better tissue sparing, as it may harm viable structures [5, 24].…”

Section: Introductionmentioning

confidence: 99%

Early functional outcome after subvastus or parapatellar approach in knee arthroplasty is comparable

Hemert

Senden

Grimm

et al. 2010

Knee Surg Sports Traumatol Arthrosc

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PurposeIn total knee arthroplasty, tissue-sparing techniques are considered more important, as functional gain could become more advantageous when early mobilization is commenced. The parapatellar approach is most often used, whereas the subvastus approach is a suitable alternative. Presently, it is unknown, according to true objective measurements, which of the two is most advantageous.MethodsIn this prospective randomized double-blind, short-term trial measurements (KSS, WOMAC, PDI, VAS, ability to perform) were obtained at day 1, day 3, 1 week, 6 weeks, and 3 months.ResultsThe subvastus group (n = 20) showed only significantly less extension lag direct postoperative (P = 0.04) compared with the parapatellar group (n = 20). Other scores were not significantly different. The Dynaport®knee test, an objective performance-based tool, could not demonstrate significant differences. A blunt anatomical dissection was carried out in both observational and histological to support findings. A dense innervation of the distal vastus medialis was found. This is at risk employing the subvastus approach. Both approaches harm the suprapatellar bursa. The vastus medialis sheath must be detached distally to open the knee joint. No true separate vastus medialis obliquus could be identified.ConclusionComparable to literature, only mild advantage employing the subvastus approach was found, but only early postoperative and not objectively. As this approach is also not suitable in every case, we will continue to use the parapatellar approach.

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Patella retention versus replacement in total knee arthroplasty; functional and clinimetric aspects

Cited by 28 publications

References 29 publications

Early outcomes of patella resurfacing in total knee arthroplasty

Early outcomes of patella resurfacing in total knee arthroplasty

Gait analysis in primary total knee arthroplasty with and without patellar resurfacing: A randomized control study

Early functional outcome after subvastus or parapatellar approach in knee arthroplasty is comparable

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