Patellar Resurfacing in Primary Total Knee Replacement: A Comparative Study at Two Years of Follow-up
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Published:
Dec 31, 2021
Keywords:
Patellar resurfacing, osteoarthritis, total knee replacement, function
Main Article Content
Abstract
Objective: To compare the functional outcomes of total knee replacement (TKR) with and without patellar resurfacing at two years of follow-up.
Materials and Methods: We carried out a retrospective observational study of patients with osteoarthritis who had undergone TKR with or without patellar resurfacing between January 2014 and December 2016 in two hospitals in Colombia. All patients received a cemented Exactech Optetrak prosthesis. Function was evaluated before surgery and after two years of follow-up with the Knee Society Score (KSS), Hospital for Special Surgery (HSS) and Oxford Knee Score (OKS).
Results: A total of 206 TKRs were included, 94 in the group with resurfacing and 112 in the group without resurfacing. The mean age was 66.9 ± 9.7 years and 76.7% (n = 155) were female. Surgical time was longer in the group with resurfacing with a median of 100 minutes (Interquartile range-IQR: 90-110) compared to 85 minutes in the group without resurfacing (IQR: 70-90), p <0.001). Although functional improvement was observed before and after TKR in both groups, the change in clinical KSS, functional KSS, and OKS scores before and after TKR was better in the resurfacing group (p <0.05).
Conclusion: Patellar resurfacing during TKR was associated with better functional outcomes at two years of follow-up. However, patients without resurfacing also reported functional improvement after TKR.
Level of Evidence: III
Materials and Methods: We carried out a retrospective observational study of patients with osteoarthritis who had undergone TKR with or without patellar resurfacing between January 2014 and December 2016 in two hospitals in Colombia. All patients received a cemented Exactech Optetrak prosthesis. Function was evaluated before surgery and after two years of follow-up with the Knee Society Score (KSS), Hospital for Special Surgery (HSS) and Oxford Knee Score (OKS).
Results: A total of 206 TKRs were included, 94 in the group with resurfacing and 112 in the group without resurfacing. The mean age was 66.9 ± 9.7 years and 76.7% (n = 155) were female. Surgical time was longer in the group with resurfacing with a median of 100 minutes (Interquartile range-IQR: 90-110) compared to 85 minutes in the group without resurfacing (IQR: 70-90), p <0.001). Although functional improvement was observed before and after TKR in both groups, the change in clinical KSS, functional KSS, and OKS scores before and after TKR was better in the resurfacing group (p <0.05).
Conclusion: Patellar resurfacing during TKR was associated with better functional outcomes at two years of follow-up. However, patients without resurfacing also reported functional improvement after TKR.
Level of Evidence: III
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How to Cite
Martínez, S., Ron-Translateur, T., Cantor, E., & Palacio, J. C. (2021). Patellar Resurfacing in Primary Total Knee Replacement: A Comparative Study at Two Years of Follow-up. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(6), 798-803. https://doi.org/10.15417/issn.1852-7434.2022.87.6.1453
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Clinical Research
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References
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patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses. Knee Surg Sport Traumatol Arthrosc 2018;26(11):3206-18. https://doi.org/10.1007/s00167-018-4831-8
9. Parsons T, Al-Jabri T, Clement ND, Maffulli N, Kader DF. Patella resurfacing during total knee arthroplasty is costeffective and has lower re-operation rates compared to non-resurfacing. J Orthop Surg Res 2021;16(1):1-9.
https://doi.org/10.1186/s13018-021-02295-8
10. Migliorini F, Eschweiler J, Niewiera M, El Mansy Y, Tingart M, Rath B. Better outcomes with patellar resurfacing
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https://doi.org/10.1007/s00402-019-03246-z
11. Schindler OS. The controversy of patellar resurfacing in total knee arthroplasty: Ibisne in medio tutissimus? Knee Surg Sport Traumatol Arthrosc 2012;20(7):1227-44. https://doi.org/10.1007/s00167-012-1985-7
12. Christopher ZK, Deckey DG, Chung AS, Spangehl MJ. Patellar osteolysis after total knee arthroplasty with patellar resurfacing: a potentially underappreciated problem. Arthroplasty Today 2019;5(4):435-41.
https://doi.org/10.1016/j.artd.2019.09.005
13. Schiavone Panni A, Cerciello S, Del Regno C, Felici A, Vasso M. Patellar resurfacing complications in total knee
arthroplasty. Int Orthop 2014;38(2):313-7. https://doi.org/10.1007/s00264-013-2244-3
14. Sandiford NA, Alao U, Salamut W, Weitzel S, Skinner JA. Patella resurfacing during total knee arthroplasty: Have we got the issue covered? CiOS Clin Orthop Surg 2014;6(4):373-8. https://doi.org/10.4055/cios.2014.6.4.373
15. Maney AJ, Koh CK, Frampton CM, Young SW. Usually, selectively, or rarely resurfacing the patella during primary total knee arthroplasty: Determining the best strategy. J Bone Joint Surg Am 2019;101(5):412-20.
https://doi.org/10.2106/JBJS.18.00389
16. Chen K, Dai X, Li L, Chen Z, Cui H, Lv S. Patellar resurfacing versus nonresurfacing in total knee arthroplasty:
an updated meta-analysis of randomized controlled trials. J Orthop Surg Res 2021;16(1):83.
https://doi.org/10.1186/s13018-020-02185-5
17. Karachalios T, Komnos G, Hantes M, Varitimidis S. Evaluating the “patella-friendly” concept in total knee
arthroplasty: A minimum 15-year follow-up outcome study comparing constant radius, multiradius cruciateretaining, and nonanatomical cruciate-retaining implants. J Arthroplasty 2021;36(8):2771-8.
https://doi.org/10.1016/j.arth.2021.03.007
18. Koh IJ, Kim MS, Sohn S, Song KY, Choi NY, In Y. Patients undergoing total knee arthroplasty using a
contemporary patella-friendly implant are unaware of any differences due to patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2019;27(4):1156-64. https://doi.org/10.1007/s00167-018-5120-2
after total joint arthroplasty. J Arthroplasty 2013;28(5):722-7. https://doi.org/10.1016/j.arth.2012.07.044
2. Martinus Breugem SJ, Haverkamp D. Anterior knee pain after a total knee arthroplasty: What can cause this pain? World J Orthop 2014;5(3):163-70. https://doi.org/10.1177/2309499020918947
3. Van Der Merwe JM, Mastel MS. Controversial topics in total knee arthroplasty: A 5-year update (Part 1). J Am Acad Orthop Surg Glob Res Rev 2020;4(1):p e19.00047. https://doi.org/10.5435/JAAOSGlobal-D-19-00047
4. Benazzo F, Perticarini L, Jannelli E, Ivone A, Ghiara M, Rossi SMP. Controversy: supporting patellar resurfacing in total knee arthroplasty – do it. EFORT Open Rev 2020;5(11):785-92. https://doi.org/10.1302/2058-5241.5.190075
5. Fraser JF, Spangehl MJ. International rates of patellar resurfacing in primary total knee arthroplasty, 2004-2014. J Arthroplasty 2017;32(1):83-6. https://doi.org/10.1016/j.arth.2016.06.010
6. Allen W, Eichinger J, Friedman R. Resurfaced versus non-resurfaced patella in total knee arthroplasty. J Knee Surg 2019;32(7):611-5. https://doi.org/10.1055/s-0039-1681077
7. Longo UG, Ciuffreda M, Mannering N, D’Andrea V, Cimmino M, Denaro V. Patellar resurfacing in total knee
arthroplasty: Systematic review and meta-analysis. J Arthroplasty 2018;33(2):620-32.
https://doi.org/10.1016/j.arth.2017.08.041
8. Grassi A, Compagnoni R, Ferrua P, Zaffagnini S, Berruto M, Samuelsson K, et al. Patellar resurfacing versus
patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses. Knee Surg Sport Traumatol Arthrosc 2018;26(11):3206-18. https://doi.org/10.1007/s00167-018-4831-8
9. Parsons T, Al-Jabri T, Clement ND, Maffulli N, Kader DF. Patella resurfacing during total knee arthroplasty is costeffective and has lower re-operation rates compared to non-resurfacing. J Orthop Surg Res 2021;16(1):1-9.
https://doi.org/10.1186/s13018-021-02295-8
10. Migliorini F, Eschweiler J, Niewiera M, El Mansy Y, Tingart M, Rath B. Better outcomes with patellar resurfacing
during primary total knee arthroplasty: a meta-analysis study. Arch Orthop Trauma Surg 2019;139(10):1445-54.
https://doi.org/10.1007/s00402-019-03246-z
11. Schindler OS. The controversy of patellar resurfacing in total knee arthroplasty: Ibisne in medio tutissimus? Knee Surg Sport Traumatol Arthrosc 2012;20(7):1227-44. https://doi.org/10.1007/s00167-012-1985-7
12. Christopher ZK, Deckey DG, Chung AS, Spangehl MJ. Patellar osteolysis after total knee arthroplasty with patellar resurfacing: a potentially underappreciated problem. Arthroplasty Today 2019;5(4):435-41.
https://doi.org/10.1016/j.artd.2019.09.005
13. Schiavone Panni A, Cerciello S, Del Regno C, Felici A, Vasso M. Patellar resurfacing complications in total knee
arthroplasty. Int Orthop 2014;38(2):313-7. https://doi.org/10.1007/s00264-013-2244-3
14. Sandiford NA, Alao U, Salamut W, Weitzel S, Skinner JA. Patella resurfacing during total knee arthroplasty: Have we got the issue covered? CiOS Clin Orthop Surg 2014;6(4):373-8. https://doi.org/10.4055/cios.2014.6.4.373
15. Maney AJ, Koh CK, Frampton CM, Young SW. Usually, selectively, or rarely resurfacing the patella during primary total knee arthroplasty: Determining the best strategy. J Bone Joint Surg Am 2019;101(5):412-20.
https://doi.org/10.2106/JBJS.18.00389
16. Chen K, Dai X, Li L, Chen Z, Cui H, Lv S. Patellar resurfacing versus nonresurfacing in total knee arthroplasty:
an updated meta-analysis of randomized controlled trials. J Orthop Surg Res 2021;16(1):83.
https://doi.org/10.1186/s13018-020-02185-5
17. Karachalios T, Komnos G, Hantes M, Varitimidis S. Evaluating the “patella-friendly” concept in total knee
arthroplasty: A minimum 15-year follow-up outcome study comparing constant radius, multiradius cruciateretaining, and nonanatomical cruciate-retaining implants. J Arthroplasty 2021;36(8):2771-8.
https://doi.org/10.1016/j.arth.2021.03.007
18. Koh IJ, Kim MS, Sohn S, Song KY, Choi NY, In Y. Patients undergoing total knee arthroplasty using a
contemporary patella-friendly implant are unaware of any differences due to patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2019;27(4):1156-64. https://doi.org/10.1007/s00167-018-5120-2