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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 11, pp 3206–3218 | Cite as

Patellar resurfacing versus patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses

  • Alberto Grassi
  • Riccardo CompagnoniEmail author
  • Paolo Ferrua
  • Stefano Zaffagnini
  • Massimo Berruto
  • Kristian Samuelsson
  • Eleonor Svantesson
  • Pietro Randelli
Knee

Abstract

Purpose

The need of patellar resurfacing in total knee arthroplasty (TKA) is a subject of debate. This systematic review of overlapping meta-analyses aimed to assess and analyze current evidence regarding patellar resurfacing and non-resurfacing in TKA.

Methods

A systematic literature search was performed in March 2017 in PubMed, CINAHL and Cochrane Library. Inclusion criteria were meta-analysis of randomized controlled trials that compared TKA with and without patellar resurfacing considering as outcomes re-operations rate, complications, anterior knee pain, functional scores. The quality of meta-analyses was evaluated with AMSTAR score and the most relevant meta-analysis was determined by applying the Jadad algorithm.

Results

Ten meta-analyses, published between 2005 and 2015, were included in the systematic review. Two studies found a significantly increased Knee Society Score in the resurfacing group. According to four meta-analyses, anterior knee pain incidence was lower in resurfacing group. Six of the included studies described a greater risk of re-intervention in the non-resurfacing groups. The overall quality of included studies was moderate. The most relevant meta-analysis reported no differences in functional scores and incidence of anterior knee pain between the groups.

Conclusions

Comparable outcomes were found when comparing patellar resurfacing and non-resurfacing in TKA. The higher risk of re-operations after non-resurfacing should be interpreted with caution due to the methodological limitations of the meta-analyses regarding search criteria, heterogeneity and the inherent bias of easier indication to reoperation when the patella is not resurfaced. There is no clear superiority of patellar resurfacing compared to patellar retention.

Level of evidence

Level II, systematic review of meta-analyses.

Keywords

Patella Arthroplasty Replacement Knee Patellar resurfacing Patellofemoral Meta-analysis Review 

Notes

Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no competing interests.

Funding

No funding has been received for this study.

Ethical approval

Ethical approval was not obtained because this study was a large database study that consist of de-identified patients records that provides anonymous information.

Informed consent

Informed consent was not obtained because this study was a retrospective review without the use of private patient information.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.Laboratorio di Biomeccanica ed Innovazione TecnologicaIstituto Ortopedico RizzoliBolognaItaly
  2. 2.ASST Centro specialistico Ortopedico Traumatologico Gaetano Pini - CTOMilanoItaly
  3. 3.IIa Clinica Ortopedica e TraumatologicaIstituto Ortopedico RizzoliBolognaItaly
  4. 4.Department of Orthopedics, Institute of Clinical Science, The Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  5. 5.Dipartimento di Scienze Biomediche per la SaluteUniversità degli Studi di MilanoMilanItaly

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