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No difference between resurfaced and non-resurfaced patellae with a modern prosthesis design: a prospective randomized study of 250 total knee arthroplasties

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Despite numerous well-conducted studies and meta-analyses, the management of the patella during total knee arthroplasty (TKA) remains controversial. The aim of our study was to compare the clinical and radiological outcomes between patients with and without patellar resurfacing and to determine the influence of resurfacing on patellar tracking with a “patella-friendly” prosthesis.

Methods

A single-centered prospective randomized controlled study was performed between April 2017 and November 2018. Two hundred and forty-five consecutive patients (250 knees) scheduled for TKA were randomized for patellar resurfacing or patella non-resurfacing. All patients received the same total knee prosthesis and were evaluated clinically and radiologically, including the International Knee Society Score (KSS knee and function), Forgotten Joint Score (FJS), anterior knee pain (AKP), pain when climbing stairs, patellar tilt, and patellar translation.

Results

Two hundred and twenty-nine knees were available for clinical evaluation and 221 knees for radiographic analysis. The revision rate for patellofemoral cause was 3.1% (7 cases) with no difference between the groups (p = 0.217). There was no difference in survival rate between patellar resurfacing (88.3%) and non-resurfacing (85.3%) after 24 months (p = 0.599). There were no differences in KSS functional component (p = 0.599), KSS knee component (p = 0.396), FJS (p = 0.798), and AKP (p = 0.688) at a mean follow-up of 18 months. There was twice as much stair pain for the non-resurfacing group (17.1% versus 8.5%) (p = 0.043). There was patellar tilt in 43% of resurfaced knees (n = 50/116) versus 29% in non-resurfaced knees (n = 30/105) (p = 0.025); however, there was more patellar translation in the non-resurfaced group (21.0% versus 7.8%) (p < 0.001). There were no specific complications attributed to the patellar resurfacing procedure. There were four secondary patellar resurfacing procedures (3.6%) in the non-resurfaced group after a mean of 10 ± 7 months (1–17) postoperatively.

Conclusion

There is no superiority of patellar resurfacing or non-resurfacing in terms of clinical or radiological outcomes at mid-term. Secondary patellar resurfacing is rare. There is not enough evidence to recommend systematic patellar resurfacing with a “patella-friendly” prosthesis.

Level of evidence

1.

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Abbreviations

BMI:

Body mass index

FJS:

Forgotten joint score

FT:

Femorotibial

HKA:

Hip knee ankle

KSS:

Knee society score

PR:

Patellar resurfacing

PNR:

Patellar non-resurfacing

OA:

Osteoarthritis

PE:

Polyethylene

PF:

Patellofemoral

RR:

Relative risk

TKA:

Total knee arthroplasty

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Acknowledgment

The present work would not have been possible without the supervision of P. Neyret (MD, PhD), who initiated the investigation. The authors specially thank Y. Herry for his personal investment in the study protocol writing.

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There is no funding source.

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Authors

Contributions

ED: data collection, statistical analysis and article writing. CB, JS, ESM, PN, ES: re-editing, interpretation of data. SL: study design and final approval of the version to be published.

Corresponding author

Correspondence to Etienne Deroche.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Clinical Research and Innovation Office on December 23, 2016 under number 2016-A01697-44. All patients signed a consent form that included a description of the protocol and the potential complications of both procedures.

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Deroche, E., Batailler, C., Swan, J. et al. No difference between resurfaced and non-resurfaced patellae with a modern prosthesis design: a prospective randomized study of 250 total knee arthroplasties. Knee Surg Sports Traumatol Arthrosc 30, 1025–1038 (2022). https://doi.org/10.1007/s00167-021-06521-y

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