Abstract
Purpose
Patellar resurfacing (PR) in total knee arthroplasty (TKA) is still one of the major controversies in orthopaedic surgery today. The aim of the present retrospective case-control study was to identify predictors for secondary patellar resurfacing (SPR) after initial TKA to create a rationale for surgeons to decide which patients to resurface primarily. It was hypothesized that proper TKA implantation and component positioning as well as a maintained physiological patellar geometry will lead to a reduced risk of SPR. Overmore, it was hypothesized that intrinsic factors like overweight might also have an influence on the need for SPR.
Methods
After identification of suitable patients and age/sex matching in a 1:2 fashion, 29 cases (TKA/SPR) and 58 controls (TKA) were included and screened for available clinical and epidemiological data as well as for radiographic data after primary TKA. Pearson’s correlation analysis as well as logistic regression modeling was performed to identify possible predictors for SPR following TKA.
Results
Binary logistic regression was able to correctly classify 88.5% of patients into case or control groups. It indicated that patella tilt, patella height, and thickness as well as the delta angle were significant predictors of a need for SPR following primary TKA. An increase in patellar width by 1 mm will increase the risk of SPR, while an increase in patellar thickness by 1 mm will reduce it. An increase in patellar tilt by 1° will also increase the risk of SPR. Finally, an increase in delta angle by 1° will again reduce the risk of SPR.
Conclusions
Easy and accessible radiographic measurements have been identified as possible predictors of SPR following primary TKA. Although indication for primary PR may still remain a controversial topic, a rationale has been proposed in this study to support surgeons in objectively estimating an individual patient’s risk for SPR prior to primary TKA measuring the patella tilt, width, and thickness. Overmore, regarding surgical aspects of TKA, tibial component positioning has also been shown to be of importance to reduce the risk of SPR.
Similar content being viewed by others
References
Schindler OS (2012) The controversy of patellar resurfacing in total knee arthroplasty: Ibisne in medio tutissimus? Knee Surg Sports Traumatol Arthrosc 20:1227–1244. https://doi.org/10.1007/s00167-012-1985-7
Franck F, Ouanezar H, Jacquel A et al (2018) The predictive factors of secondary patellar resurfacing in computer-assisted total knee arthroplasty. A prospective cohort study. Int Orthop 42:1051–1060. https://doi.org/10.1007/s00264-017-3630-z
Wood DJ, Smith AJ, Collopy D et al (2002) Patellar resurfacing in total knee arthroplasty: a prospective, randomized trial. J Bone Joint Surg Am 84-A:187–193
Helmy N, Anglin C, Greidanus NV, Masri BA (2008) To resurface or not to resurface the patella in total knee arthroplasty. Clin Orthop Relat Res 466:2775–2783. https://doi.org/10.1007/s11999-008-0420-3
Leichtle UG, Lange B, Herzog Y et al (2017) Influence of different patellofemoral design variations based on Genesis II total knee endoprosthesis on patellofemoral pressure and kinematics. Appl Bionics Biomech 2017:5492383–5492310. https://doi.org/10.1155/2017/5492383
Lee GW, Lee S-M, Jang S-J, Son J-H (2013) The efficacy of patellar decompression for improving anterior knee pain following total knee arthroplasty without patellar resurfacing. Arch Orthop Trauma Surg 133:561–567. https://doi.org/10.1007/s00402-013-1702-0
Cerciello S, Robin J, Lustig S et al (2016) The role of patelloplasty in total knee arthroplasty. Arch Orthop Trauma Surg 136:1607–1613. https://doi.org/10.1007/s00402-016-2577-7
Waters TS, Bentley G (2003) Patellar resurfacing in total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am 85-A:212–217
Popovic N, Lemaire R (2003) Anterior knee pain with a posterior-stabilized mobile-bearing knee prosthesis: the effect of femoral component design. J Arthroplast 18:396–400
Petersen W, Rembitzki IV, Brüggemann G-P et al (2014) Anterior knee pain after total knee arthroplasty: a narrative review. Int Orthop 38:319–328. https://doi.org/10.1007/s00264-013-2081-4
Enis JE, Gardner R, Robledo MA et al (1990) Comparison of patellar resurfacing versus nonresurfacing in bilateral total knee arthroplasty. Clin Orthop Relat Res 260:38–42
Pavlou G, Meyer C, Leonidou A et al (2011) Patellar resurfacing in total knee arthroplasty: does design matter? A meta-analysis of 7075 cases. J Bone Joint Surg Am 93:1301–1309. https://doi.org/10.2106/JBJS.J.00594
Werth L, Saffarini M, Amsler F et al (2017) The need for secondary resurfacing is affected by trochlear height in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:3818–3823. https://doi.org/10.1007/s00167-016-4319-3
Nizard RS, Biau D, Porcher R et al (2005) A meta-analysis of patellar replacement in total knee arthroplasty. Clin Orthop Relat Res 436:196–203
Pilling RWD, Moulder E, Allgar V et al (2012) Patellar resurfacing in primary total knee replacement: a meta-analysis. J Bone Joint Surg Am 94:2270–2278. https://doi.org/10.2106/JBJS.K.01257
Pakos EE, Ntzani EE, Trikalinos TA (2005) Patellar resurfacing in total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 87:1438–1445. https://doi.org/10.2106/JBJS.D.02422
Li S, Chen Y, Su W et al (2011) Systematic review of patellar resurfacing in total knee arthroplasty. Int Orthop 35:305–316. https://doi.org/10.1007/s00264-010-1109-2
van Hemert WLW, Senden R, Grimm B et al (2009) Patella retention versus replacement in total knee arthroplasty; functional and clinimetric aspects. Arch Orthop Trauma Surg 129:259–265. https://doi.org/10.1007/s00402-008-0640-8
Caton J (1989) Method of measuring the height of the patella. Acta Orthop Belg 55:385–386
Grelsamer RP, Bazos AN, Proctor CS (1993) Radiographic analysis of patellar tilt. J Bone Joint Surg (Br) 75:822–824
Ewald FC (1989) The knee society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12
McCalden RW, Hart GP, MacDonald SJ et al (2017) Clinical results and survivorship of the GENESIS II total knee arthroplasty at a minimum of 15 years. J Arthroplast 32:2161–2166. https://doi.org/10.1016/j.arth.2017.02.006
Assi C, Kheir N, Samaha C et al (2017) Optimizing patellar positioning during total knee arthroplasty: an anatomical and clinical study. Int Orthop 41:2509–2515. https://doi.org/10.1007/s00264-017-3557-4
Calvisi V, Camillieri G, Lupparelli S (2009) Resurfacing versus nonresurfacing the patella in total knee arthroplasty: a critical appraisal of the available evidence. Arch Orthop Trauma Surg 129:1261–1270. https://doi.org/10.1007/s00402-008-0801-9
Li N, Tan Y, Deng Y, Chen L (2014) Posterior cruciate-retaining versus posterior stabilized total knee arthroplasty: a meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 22:556–564. https://doi.org/10.1007/s00167-012-2275-0
Muñoz-Mahamud E, Popescu D, Nuñez E et al (2011) Secondary patellar resurfacing in the treatment of patellofemoral pain after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:1467–1472. https://doi.org/10.1007/s00167-011-1402-7
Daniilidis K, Vogt B, Gosheger G et al (2012) Patellar resurfacing as a second stage procedure for persistent anterior knee pain after primary total knee arthroplasty. Int Orthop 36:1181–1183. https://doi.org/10.1007/s00264-011-1463-8
Parvizi J, Mortazavi SMJ, Devulapalli C et al (2012) Secondary resurfacing of the patella after primary total knee arthroplasty does the anterior knee pain resolve? J Arthroplast 27:21–26. https://doi.org/10.1016/j.arth.2011.04.027
Scheurer P, Reininga IHF, van Jonbergen H-PW, van Raay JJAM (2015) Secondary patellar resurfacing following total knee arthroplasty: a cohort study in fifty-eight knees with a mean follow-up of thirty one months. Int Orthop 39:1301–1306. https://doi.org/10.1007/s00264-015-2684-z
Prudhon JL, Caton JH, Aslanian T, Verdier R (2018) How is patella height modified after total knee arthroplasty? Int Orthop 42:311–316. https://doi.org/10.1007/s00264-017-3539-6
Huang A-B, Luo X, Song C-H et al (2015) Comprehensive assessment of patellar morphology using computed tomography-based three-dimensional computer models. Knee 22:475–480. https://doi.org/10.1016/j.knee.2015.05.010
Huang A-B, Qi Y-S, Song C-H et al (2016) Novel customized template designing for patellar resurfacing in total knee arthroplasty. J Orthop Res 34:1798–1803. https://doi.org/10.1002/jor.23200
Pagenstert G, Seelhoff J, Henninger HB et al (2014) Lateral patellar facetectomy and medial reefing in patients with lateral facet syndrome after patellar-retaining total knee arthroplasty. J Arthroplast 29:2156–2162. https://doi.org/10.1016/j.arth.2014.06.014
Nedopil AJ, Howell SM, Hull ML (2017) What clinical characteristics and radiographic parameters are associated with patellofemoral instability after kinematically aligned total knee arthroplasty? Int Orthop 41:283–291. https://doi.org/10.1007/s00264-016-3287-z
Hernigou P, Deschamps G (2004) Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am 86-A:506–511
Marra MA, Strzelczak M, Heesterbeek PJC et al (2018) Anterior referencing of tibial slope in total knee arthroplasty considerably influences knee kinematics: a musculoskeletal simulation study. Knee Surg Sports Traumatol Arthrosc 26:1540–1548. https://doi.org/10.1007/s00167-017-4561-3
Ogon M, Hartig F, Bach C et al (2002) Patella resurfacing: no benefit for the long-term outcome of total knee arthroplasty. A 10- to 16.3-year follow-up. Arch Orthop Trauma Surg 122:229–234. https://doi.org/10.1007/s00402-001-0364-5
Acknowledgements
The authors wish to thank Johannes Wagenhaeuser, MD, for his kind support in obtaining the radiographic datasets.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. Additional approval for this study was obtained from the institutional review board of our hospital (study no. 224/17).
Rights and permissions
About this article
Cite this article
Roessler, P.P., Moussa, R., Jacobs, C. et al. Predictors for secondary patellar resurfacing after primary total knee arthroplasty using a “patella-friendly” total knee arthroplasty system. International Orthopaedics (SICOT) 43, 611–617 (2019). https://doi.org/10.1007/s00264-018-4075-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-018-4075-8