Functional and radiological outcome of patella resurfacing vs non-resurfacing in total knee replacement
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20254213Keywords:
Feller patellar score, Knee society score, Patellar resurfacing, Total knee replacementAbstract
Background: The knee joint is crucial for gait and mobility and osteoarthritis remains its most common debilitating condition. Total knee replacement (TKR) is the standard treatment, though controversy persists regarding patellar resurfacing. While anterior knee pain (AKP) is a leading source of dissatisfaction after TKR, resurfacing carries risks such as subluxation, fracture and loosening. The debate continues, particularly in populations with differing anatomy and lifestyle. To compare functional and radiological outcomes of TKR with versus without patellar resurfacing in a South Indian population.
Methods: This prospective comparative study was conducted at IORAS, Madurai, between August 2018 and July 2020. Out of 200 TKRs, 110 patients met inclusion criteria and were evenly divided into two groups: one underwent TKR with patellar resurfacing and the other without. All surgeries were performed by the same surgeon using the Posterior Stabilized Insall Burstein II knee system. Outcome measures included Knee Society Score (pain and function), Feller patellar score and radiographic patellar tilt, with follow-up at one year.
Results: At one year, no statistically significant differences were observed between resurfacing and non-resurfacing groups across pain, function, patellar scores or patellar tilt angles (p>0.05).
Conclusions: Patellar resurfacing offered no short-term advantage over non-resurfacing in terms of functional or radiological outcomes. Given the complexity of pain perception and lifestyle variability, further long-term studies are warranted. Each TKR case remains unique and modifying a single surgical variable is unlikely to change outcomes significantly.
References
Drake RL, Vogl WA, Mitchell AW. Gray's Atlas der Anatomie: Deutsche Bearbeitung von Lars Bräuer. Else Health Sci. 2021;4:864.
Adam R. F, Noble J.Primary total knee arthroplasty in the elderly, J. Arthroplasty 9 : 495, 1994.
Barrack RL, Wolfe MW. Patellar resurfacing in total knee arthroplasty. J Am Acad Orthop Surg. 2000;8:75-82.
Patel K, Raut V. Patella in total knee arthroplasty: To resurface or not to – A cohort study of staged bilateral total knee arthroplasty. Int Orthop. 2011;35:349-53.
Gomes LS, Bechtold JE, Gustilo RB. Patellar prosthesis positioning in total knee arthroplasty. A roentgenographic study. Clin Orthop Relat Res. 1988;(236):72-81.
Rosenberg AG. Management of the failed metal-backed patella. Orthopedics. 1996;19:813-5.
Rand JA. Extensor mechanism complications following total knee arthroplasty. J Bone Jt Surg. 2004;86:2062-72
Calvisi V, Camillieri G, Lupparelli S. Resurfacing versus nonresurfacing the patella in total knee arthroplasty: A critical appraisal of the available evidence. Arch Orthop Trauma Surg. 2009;129:1261-70.
Nizard RS, Biau D, Porcher R, Ravaud P, Bizot P, Hannouche D, et al. A meta-analysis of patellar replacement in total knee arthroplasty. Clin Orthop Relat Res. 2005;432:196-203.
Kim BS, Reitman RD, Schai PA, Scott RD. Selective patellar nonresurfacing in total knee arthroplasty. 10 year results. Clin Orthop Relat Res. 1999;367:81-8.
Pakos EE, Ntzani EE, Trikalinos TA. Patellar resurfacing in total knee arthroplasty. A meta- analysis. J Bone Joint Surg Am. 2005;87:1438-45.
Fu Y, Wang G, Fu Q. Patellar resurfacing in total knee arthroplasty for osteoarthritis: A meta- analysis. Knee Surg Sports Traumatol Arthrosc. 2011;19:1460-6.
He JY, Jiang LS, Dai LY. Is patellar resurfacing superior than nonresurfacing in total knee arthroplasty. A meta-analysis of randomized trials. Knee. 2011;18:137-44.
Pavlou G, Meyer C, Leonidou A, As-Sultany M, West R, Tsiridis E, et al. Patellar resurfacing in total knee arthroplasty: Does design matter? A meta-analysis of 7075 cases. J Bone Joint Surg Am. 2011;93:1301-9.
Chen K, Li G, Fu D, Yuan C, Zhang Q, Cai Z, et al. Patellar resurfacing versus nonresurfacing in total knee arthroplasty: A meta-analysis of randomised controlled trials. Int Orthop. 2013;37:1075-83.
Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the knee society clinical rating system. Clin Orthop Relat Res. 1989;248:13-4.
Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br. 1996;78:226-8.
Grelsamer RP, Bazos AN, Proctor CS. Radiographic analysis of patellar tilt. J Bone Joint Surg. 1993;75(5):822-4.
Waters TS, Bentley G. Patellar resurfacing in total knee arthroplasty. J Bone Joint Surg Am. 2003;85:212–7.
Newman JH, Ackroyd CE, Shah NA. Should the patella be resurfaced during total knee replacement. Knee. 2000;7:17–23.
Campbell DG, Duncan WW, Ashworth M. Patellar resurfacing in total knee arthroplasty: a ten-year randomised prospective trial. J Bone Joint Surg Br. 2006;88:734-9.
Barrack RL, Bertot AJ, Wolfe MW. Patellar resurfacing in total knee arthroplasty. A prospective, randomised, double-blind study with f ive to seven years of follow-up. J Bone Joint Surg Am. 2001;83:1376-81.
Murray DW, MacLennan GS, Breeman S. A randomized controlled trial of the clinical effectiveness and cost-effectiveness of different knee prostheses: the Knee Arthroplasty Trial (KAT). Health Technol. 2014;18:1-235.
Keating EM, Faris PM, Meding JB. Comparison of the midvastusmuscle-splitting approach with the median parapatellar approach in total knee arthroplasty. J Arthroplasty. 1999;14:29-32.
Lygre SH, Espehaug B, Havelin LI. Does patella resurfacing really matter. Pain and function in 972 patients after primary total knee arthroplasty. Acta Orthop. 2010;81:99-107.
Abraham W, Buchanan JR, Daubert H. Should the patella be resurfaced in total knee arthroplasty. Efficacy of patellar resurfacing. Clin Orthop. 1988;236:128–34.
Keblish PA, Varma AK, Greenwald AS. Patellar resurfacing or retention in total knee arthroplasty. A prospective study of patients with bilateral replacement. J Bone Joint Surg Am. 1994;76:930–7.
Levani J-P, McLeod HC, Freeman MAR: Why not resurface the patella. J Bone Joint Surg Br. 1983;65:448-51.
Thompson NW, Ruiz AL, Breslin E. Total knee arthroplasty without patellar resurfacing in isolated patellofemoral osteoarthritis. J Arthroplasty. 2001;16:607–12.
Bourne RB, Burnett RSJ. The consequences of not resurfacing the patella. Clin Orthop. 2004;428:166–9.
Smith AJ, Wood DJ, Li MG. Total knee replacement with and without Patellar resurfacing: a prospective, randomised trial using the Profix total knee system. J Bone Joint Surg Br. 2008;90:43-9.
Kim BS, Reitman RD, Schai PA. Selective patellar no resurfacing in total knee arthroplasty. 10 year results. Clin Orthop. 1999;367:81–8.
Hasegawa M, Ohashi T. Long-term clinical results and radiographic changes in the nonresurfaced patella after total knee arthroplasty: 78 knees followed for mean 12 years. Acta Orthop Scand. 2002;71:539-45.
Scott RD, Reilly DT: Pros and cons of patellar resurfacing in total knee replacement. Orthop Trans. 1980;4:328.
Scuderi GR, Insall JN, Scott NW. Patellofemoral pain after total knee arthroplasty. J Am Acad Orthop Surg. 1994;2:239-246.
Newman JH, Ackroyd CE, Shah NA, et al. Should the patella be resurfaced during total knee replacement. Knee. 2000;7:17-23.
Thompson NW, Ruiz AL, Breslin E. Total knee arthroplasty without patellar resurfacing in isolated patellofemoral osteoarthritis. J Arthroplasty. 2001;16:607–12.
Sledge CB, Ewald FC. Total knee arthroplasty experience at the Robert Breck Brigham Hospital. Clin Orthop. 1979;145:74-84.
Usman MA, Yurianto H, Rahmansyah N, Anwar SFZ. Functional outcome and cost effectiveness of patellar resurfacing and non-resurfacing in total knee arthroplasty: systematic review and meta-analysis. J Orthop Surg Res. 2025;20;20(1):492.
Downloads
Published
How to Cite
Issue
Section
