Skip to main content
SpringerLink
Log in

Patella resurfacing is not associated with a difference in the Oxford knee score after total knee arthroplasty but stair descent is enhanced

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

The primary aim was to assess the Oxford knee scores (OKS) on patients who underwent a total knee arthroplasty (TKA) with patellar resurfacing compared to those who did not. Secondary aims were to identify: (1) factors associated with resurfacing, (2) the effect of resurfacing on specific components of the OKS related to patellofemoral function, (3) the influence on patient satisfaction, and (4) whether a subgroup of patients had an improved outcome when resurfacing was undertaken.

Methods

A retrospective cohort study was undertaken using outcome data from the arthroplasty database held at the study centre. Patient demographics and OKS were collected preoperatively and at 1 and 2 years postoperatively. Patient satisfaction was assessed at 1 and 2 years postoperatively.

Results

Three thousand one hundred and twenty-two patients met the inclusion criteria of which 46.5% (n = 1453) underwent resurfacing. There were no differences in the OKS change at 1 or 2 years between those undergoing and not undergoing resurfacing (difference 0.2, p ≥ 0.469). Patients undergoing resurfacing were more likely to be female (odds ratio (OR) 1.53, 95% CI 1.30–1.79, p < 0.001), undergo a posterior stabilised knee (OR 6.87, 95% CI 5.71–8.27, p < 0.001) or had a worse response to question 5—standing from a chair, (p = 0.011) or 12—stair descent, (p = 0.017) of the OKS preoperatively. There was no difference in postoperative patient satisfaction (p ≥ 0.180). There was a significantly greater improvement in question 12 of the OKS at 1 year (p = 0.019) in the resurfaced group. There were no patient-related factors or symptoms that were associated with a clinically significant (≥ 5 points) greater postoperative OKS.

Conclusion

Patella resurfacing was not associated with a clinically important improvement in OKS. No specific indications for patella resurfacing were identified that offered an improved outcome, but when it was undertaken there was a greater improvement in the ability to descend stairs.

Level of evidence Retrospective diagnostic study, Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and material

Data are available on request to the corresponding authors should it be required, but this would have to be authorised by the study centre audit team.

Notes

  1. Implants: (PFC Sigma (Depuy), Genesis II (Smith and Nephew), BKR (JointMedica), TC PLUS (Smith and Nephew), LCS (Depuy), Attune (Depuy), Unity (Corin), Vanguard (Zimmer Biomet), NexGen (Zimmer Biomet), GMK Sphere (Medacta), MRK (MatOrtho), SAIPH (MatOrtho), EndoModel (LINK), and NOILES (DEPUY).

References

  1. Parsons T, Al-Jabri T, Clement ND, Maffulli N, Kader DF (2021) Patella resurfacing during total knee arthroplasty is cost-effective and has lower re-operation rates compared to non-resurfacing. J Orthop Surg Res 16(1):185

    PubMed  PubMed Central  Google Scholar 

  2. Fraser J, Spangehl M (2017) International rates of patellar resurfacing in primary total knee arthroplasty, 2004–2014. J Arthroplasty 32(1):83–86

    PubMed  Google Scholar 

  3. Ben-Shlomo Y, Blom A, Boulton C, et al. The National Joint Registry 17th Annual Report 2020. National Joint Registry, London; 2020. Last accessed 4/4/21.

  4. Parvizi J, Rapuri VR, Saleh KJ, Kuskowski MA, Sharkey PF, Mont MA (2005) Failure to resurface the patella during total knee arthroplasty may result in more knee pain and secondary surgery. Clin Orthop Relat Res 438:191–196

    PubMed  Google Scholar 

  5. Migliorini F, Eschweiler J, Niewiera M, El Mansy Y, Tingart M, Rath B (2019) Better outcomes with patellar resurfacing during primary total knee arthroplasty: a meta-analysis study. Arch Orthop Trauma Surg 139(10):1445–1454

    PubMed  Google Scholar 

  6. Tang XB, Wang J, Dong PL, Zhou R (2018) A Meta-analysis of patellar replacement in total knee arthroplasty for patients with knee osteoarthritis. J Arthroplasty 33(3):960–967

    PubMed  Google Scholar 

  7. Nizard RS, Biau D, Porcher R, Ravaud P, Bizot P, Hannouche D, Sedel L (2005) A meta-analysis of patellar replacement in total knee arthroplasty. Clin Orthop Relat Res 432:196–203

    Google Scholar 

  8. Teel AJ, Esposito JG, Lanting BA, Howard JL, Schemitsch EH (2019) Patellar resurfacing in primary total knee arthroplasty: a meta-analysis of randomized controlled trials. J Arthroplasty 34(12):3124–3132

    PubMed  Google Scholar 

  9. Pilling RW, Moulder E, Allgar V, Messner J, Sun Z, Mohsen A (2012) Patellar resurfacing in primary total knee replacement: a meta-analysis. J Bone Joint Surg Am 94(24):2270–2278

    CAS  PubMed  Google Scholar 

  10. He JY, Jiang LS, Dai LY (2011) Is patellar resurfacing superior than nonresurfacing in total knee arthroplasty? A meta-analysis of randomized trials. Knee 18(3):137–144

    PubMed  Google Scholar 

  11. Pavlou G, Meyer C, Leonidou A, As-Sultany M, West R, Tsiridis E (2011) Patellar resurfacing in total knee arthroplasty: does design matter? A meta-analysis of 7075 cases. J Bone Jt Surg Am 93(14):1301–1309

    Google Scholar 

  12. NICE. Joint replacement (primary): hip, knee and shoulder. Evidence review for patella resurfacing. NICE guideline NG157. https://www.nice.org.uk/guidance/ng157/evidence/l-patella-resurfacing-pdf-315756469335. Accessed 22 Apr 2021

  13. Sandiford NA, Alao U, Salamut W, Weitzel S, Skinner JA (2014) Patella resurfacing during total knee arthroplasty: have we got the issue covered? Clin Orthop Surg 6(4):373–378

    PubMed  PubMed Central  Google Scholar 

  14. Schindler OS (2012) The controversy of patellar resurfacing in total knee arthroplasty: Ibisne in medio tutissimus? Knee Surg Sports Traumatol Arthrosc 20(7):1227–1244

    PubMed  PubMed Central  Google Scholar 

  15. Cho WJ, Bin SI, Kim JM, Lee BS, Sohn DW, Kwon YH (2018) Total knee arthroplasty with patellar retention: the severity of patellofemoral osteoarthritis did not affect the clinical and radiographic outcomes. J Arthroplasty 33(7):2136–2140

    PubMed  Google Scholar 

  16. Holland G, Keenan OJ, Gillespie M, Gherman A, MacDonald DJ, Clement ND, Scott CEH (2021) Patellar cartilage loss does not affect early outcomes of total knee arthroplasty performed without patella resurfacing. Knee 28:194–201

    PubMed  Google Scholar 

  17. Han I, Chang CB, Lee S, Lee MC, Seong SC, Kim TK (2005) Correlation of the condition of the patellar articular cartilage and patellofemoral symptoms and function in osteoarthritic patients undergoing total knee arthroplasty. J Bone Jt Surg Br 87(8):1081–1084

    CAS  Google Scholar 

  18. Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80:63–69

    CAS  PubMed  Google Scholar 

  19. Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72

    CAS  PubMed  Google Scholar 

  20. Beard DJ, Harris K, Dawson J, Doll H, Murray DW, Carr AJ, Price AJ (2015) Meaningful changes for the Oxford hip and knee scores after joint replacement surgery. J Clin Epidemiol 68(1):73–79

    PubMed  PubMed Central  Google Scholar 

  21. Clement ND, MacDonald D, Simpson AH (2014) The minimal clinically important difference in the Oxford knee score and Short Form 12 score after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:1933–1939

    CAS  PubMed  Google Scholar 

  22. Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33(5):337–343

    CAS  PubMed  Google Scholar 

  23. World Medical Association (2013) World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310(20):2191–2194

    Google Scholar 

  24. Lizaur-Utrilla A, Gonzalez-Parreño S, Martinez-Mendez D, Miralles-Muñoz FA, Lopez-Prats FA (2020) Minimal clinically important differences and substantial clinical benefits for Knee Society Scores. Knee Surg Sports Traumatol Arthrosc 28(5):1473–1478

    PubMed  Google Scholar 

  25. Longo UG, Ciuffreda M, Mannering N, D’Andrea V, Cimmino M, Denaro V (2018) Patellar resurfacing in total knee arthroplasty: systematic review and meta-analysis. J Arthroplasty 33(2):620–632

    PubMed  Google Scholar 

  26. Chen K, Li G, Fu D, Yuan C, Zhang Q, Cai Z (2013) Patellar resurfacing versus nonresurfacing in total knee arthroplasty: a meta-analysis of randomised controlled trials. Int Orthop 37(6):1075–1083

    PubMed  PubMed Central  Google Scholar 

  27. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    Google Scholar 

  28. Clement ND, Afzal I, Demetriou C, Deehan DJ, Field RE, Kader DF (2020) The preoperative Oxford Knee Score is an independent predictor of achieving a postoperative ceiling score after total knee arthroplasty. Bone Jt J. 102-B(11):1519–1526

    Google Scholar 

  29. Behrend H, Giesinger K, Giesinger JM, Kuster MS (2012) The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplasty 27(3):430-436.e1

    PubMed  Google Scholar 

  30. Hamilton DF, Loth FL, Giesinger JM, Giesinger K, MacDonald DJ, Patton JT, Simpson AH, Howie CR (2017) Validation of the English language Forgotten Joint Score-12 as an outcome measure for total hip and knee arthroplasty in a British population. Bone Jt J. 99-B(2):218–224

    CAS  Google Scholar 

  31. Adriani M, Malahias MA, Gu A, Kahlenberg CA, Ast MP, Sculco PK (2020) Determining the validity, reliability, and utility of the forgotten joint score: a systematic review. J Arthroplasty 35(4):1137–1144

    PubMed  Google Scholar 

  32. Harris K, Dawson J, Doll H, Field RE, Murray DW, Fitzpatrick R, Jenkinson C, Price AJ, Beard DJ (2013) Can pain and function be distinguished in the Oxford knee score in a meaningful way? An exploratory and confrmatory factor analysis. Qual Life Res 22(9):2561–2568

    PubMed  Google Scholar 

  33. Harris K, Lim CR, Dawson J, Fitzpatrick R, Beard DJ, Price AJ (2017) The Oxford knee score and its subscales do not exhibit a ceiling or a floor effect in knee arthroplasty patients: an analysis of the National Health Service PROMs data set. Knee Surg Sports Traumatol Arthrosc 25(9):2736–2742

    PubMed  Google Scholar 

  34. Yassa R, Khalfaoui MY, Davies AP (2016) Are “Patellofemoral Symptoms” Truly Related to the Patellofemoral Joint? Knee Surg Relat Res 28(1):68–74

    PubMed  PubMed Central  Google Scholar 

  35. Chua J, Goh GSH, Liow ML (2019) Modern TKA implants are equivalent to traditional TKA implants in functional and patellofemoral joint-related outcomes. Knee Surg Sports Traumatol Arthrosc 27:1116–1123

    PubMed  Google Scholar 

  36. Baker PN, Petheram T, Dowen D, Jameson SS, Avery PJ, Reed MR, Deehan DJ (2014) Early PROMs following total knee arthroplasty–functional outcome dependent on patella resurfacing. J Arthroplasty 29(2):314–319

    PubMed  Google Scholar 

  37. Clement ND, Ng N, MacDonald D, Scott CEH, Howie CR (2020) One-year Oxford knee scores should be used in preference to 6-month scores when assessing the outcome of total knee arthroplasty. Knee Surg Relat Res 32(1):43

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Williams DP, Blakey CM, Hadfield SG, Murray DW, Price AJ, Field RE (2013) Long-term trends in the Oxford knee score following total knee replacement. Bone Jt J 95-B(1):45–51

    CAS  Google Scholar 

  39. Scott CE, Nutton RW, Biant LC (2013) Lateral compartment osteoarthritis of the knee: Biomechanics and surgical management of end-stage disease. Bone Jt J. 95-B(4):436–444

    CAS  Google Scholar 

  40. van Vollenhoven RF (2009) Sex differences in rheumatoid arthritis: more than meets the eye. BMC Med 7:12

    PubMed  PubMed Central  Google Scholar 

  41. Hinman RS, Crossley KM (2007) Patellofemoral joint osteoarthritis: an important subgroup of knee osteoarthritis. Rheumatology 46(7):1057–1062

    CAS  PubMed  Google Scholar 

  42. Costigan PA, Deluzio KJ, Wyss UP (2002) Knee and hip kinetics during normal stair climbing. Gait Posture 16(1):31–37

    PubMed  Google Scholar 

  43. Chen YJ, Scher I, Powers CM (2010) Quantification of patellofemoral joint reaction forces during functional activities using a subject-specific three-dimensional model. J Appl Biomech 26(4):415–423

    CAS  PubMed  Google Scholar 

  44. Matharu GS, Blom AW, Venkatesh R, Metcalfe AJ, Whitehouse MR (2021) Patellar resurfacing practices in primary total knee replacement: a survey of BASK members. Knee 28:A3–A5

    Google Scholar 

  45. Ross LA, O’Rourke SC, Toland G, MacDonald DJ, Clement ND, Scott CEH (2022) Loss to patient-reported outcome measure follow-up after hip arthroplasty and knee arthroplasty: patient satisfaction, associations with non-response, and maximizing returns. Bone Jt Open 3(4):275–283

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors of this manuscript would like to thank the Research and Outcomes Team at the South West London Elective Orthopaedic Centre for their handwork and support in the data collection process.

Funding

No funding was received to assist with the preparation of this manuscript. No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Croydon University Hospital, 530 London Road, Thornton Heath, CR7 7YE, UK

    Sarah Abbott & Sarkhell Radha

  2. Academic Surgical Unit, South West London Elective Orthopaedic Centre, Dorking Road, Epsom, KT18 7EG, UK

    Sarkhell Radha, Irrum Afzal, Karam Sarsam, Nick D. Clement & Deiary F. Kader

  3. Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Cres, Old Dalkeith Road, Edinburgh, EH16 4SA, UK

    Nick D. Clement

Authors
  1. Sarah Abbott
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarkhell Radha
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Irrum Afzal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karam Sarsam
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nick D. Clement
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Deiary F. Kader
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SA wrote the manuscript and edited the manuscript. SR, NDC and IA provided concept and data analysis and wrote the manuscript. KS performed data analysis and wrote the manuscript. DFK provided the concept and edited the manuscript.

Corresponding author

Correspondence to Irrum Afzal.

Ethics declarations

Conflict of interest statement

The authors declare no conflicts of interest.

Ethics approval and consent to participate

There was no additional patient contact, and as such, this project was performed as a service evaluation without the need for formal ethical approval. The project was registered with the institutions audit department and was conducted in accordance with the Declaration of Helsinki and the guidelines for good clinical practice.

Consent for publication

Only anonymous data were analysed and used in this study in accordance with the audit department at the study centre.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abbott, S., Radha, S., Afzal, I. et al. Patella resurfacing is not associated with a difference in the Oxford knee score after total knee arthroplasty but stair descent is enhanced. Arch Orthop Trauma Surg 143, 5333–5343 (2023). https://doi.org/10.1007/s00402-022-04733-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-022-04733-6

Keywords

Search

Navigation