The predictive factors of secondary patellar resurfacing in computer-assisted total knee arthroplasty. A prospective cohort study
- 328 Downloads
The decision to resurface the patella during total knee arthroplasty (TKA) remains controversial. This prospective cohort study aimed to evaluate the outcome and survivorship of the native patella in computer-assisted TKA (CAS TKA) implanted for primary knee osteoarthritis, and to determine the predictive factors of secondary patellar resurfacing (SPR).
A prospective cohort of 273 cementless ultra-congruent mobile-bearing CAS TKA implanted without patellar resurfacing was included in our total joint registry. Patients were evaluated with the International Knee Society (IKS) and Hospital for Special Surgery Patellar (HSSP) scores. Radiographic evaluation was focused on the patellofemoral (PF) compartment to assess: the patellar dysplasia (Wiberg classification), PF osteoarthritis (Iwano classification), femoral trochlear dysplasia (femoral sulcus angle), patellar maltracking (patellar tilt and lateralization), and patella height (Blackburne-Peel ratio).
At a six-year median follow-up, the CAS TKA survivorship using SPR as end-point was 95% (range, 91–99%). The IKS and HSSP improved significantly after SPR (p = 0.001 and 0.004, respectively). No significant difference in the IKS and HSSP was detected between TKA with native patella and SPR-TKA at latest follow-up. Importantly, four pre-operative radiographic PF parameters were significantly associated with SPR: higher stages of patellar dysplasia and PF osteoarthritis, and higher sulcus angle and patellar lateralization (hazard ratios = 5.1 to 11.6, p = 0.009 to 0.04).
When preserving the native patella, surgeons should be aware of pre-operative PF radiographic parameters that could influence the outcome and survivorship of CAS TKA leading to SPR. Particularly, evidence of PF dysplasia, osteoarthritis and maltracking should be determined pre-operatively to resurface the patella at the time of TKA.
Level of evidence
Therapeutic Level II (prospective cohort study)
KeywordsTotal knee arthroplasty Computer-assisted surgery Survivorship Secondary patellar resurfacing Predictive factors
The authors thank Mr. Jerôme CRETON for providing assistance in statistical analyses.
No external source of funding was obtained for this study.
Compliance with ethical standards
Conflict of interest
FF, HO, AJ and JW declare that they have no conflict of interest. VP declares royalties perceived from Amplitude, Valence, France.
All procedures performed in this study involving human participants were in accordance with the ethical standards of our institution and the French national research committees, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in this study.
- 10.Lygre SH, Espehaug B, Havelin LI, Vollset SE, Furnes O (2010) Does patella resurfacing really matter? Pain and function in 972 patients after primary total knee arthroplasty. An observational study from the Norwegian Arthroplasty register. Acta Orthop 81:99–107. https://doi.org/10.3109/17453671003587069 CrossRefPubMedGoogle Scholar
- 12.Breeman S, Campbell M, Dakin H, Fiddian N, Fitzpatrick R, Grant A, Gray A, Johnston L, Maclennan G, Morris R, Murray D, KAT Trial Group (2011) Patellar resurfacing in total knee replacement: five-year clinical and economic results of a large randomized controlled trial. J Bone Joint Surg Am 93:1473–1481. https://doi.org/10.2106/JBJS.J.00725 CrossRefPubMedGoogle Scholar
- 18.Leta TH, Lygre SH, Skredderstuen A, Hallan G, Gjersten JE, Rokne B, Furnes O (2016) Secondary patella resurfacing in painful non-resurfaced total knee arthroplasties. A study of survival and clinical outcome from the Norwegian Arthroplasty register (1994-2011). Int Orthop 40:715–722. https://doi.org/10.1007/s00264-015-3017-y CrossRefPubMedGoogle Scholar
- 19.Munoz-Mahamud E, Popescu D, Nunez E, Lozano LM, Nunez M, Sastre S, Torner P, Segur JM, Macule F (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 CrossRefPubMedGoogle Scholar
- 22.Toro-Ibarguen AN, Navarro-Arribas R, Pretell-Mazzini J, Prada-Canizares AC, Jara-Sanchez F (2016) Secondary patellar resurfacing as a rescue procedure for persistent anterior knee pain after primary total knee arthroplasty: do our patients really improve? J Arthroplast 31:1539–1543. https://doi.org/10.1016/j.arth.2016.01.001 CrossRefGoogle Scholar
- 24.Ouanezar H, Franck F, Jacquel A, Pibarot V, Wegrzyn J (2016) Does computer-assisted surgery influence survivorship of cementless total knee arthroplasty in patients with primary osteoarthritis? A 10-year follow-up study. Knee Surg Sports Traumatol Arthrosc 24:3448–3456. https://doi.org/10.1007/s00167-016-4112-3 CrossRefPubMedGoogle Scholar
- 30.Assi C, Kheir N, Samaha C, Deeb M, Yammine K (2017) Optimizing patellar positioning during total knee arthroplasty: an anatomical and clinical study. Int Orthop. https://doi.org/10.1007/s00264-017-3557-4
- 31.Baldini A, Anderson JA, Zampetti P, Pavlov H, Sulco TP (2006) A new patellofemoral scoring system for total knee arthroplasty. Clin Orthop Relat Res 452:150–154. https://doi.org/10.1097/01.blo.0000238847.34047.90 CrossRefPubMedGoogle Scholar
- 32.Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14Google Scholar
- 34.Prudhon JL, Caton JH, Aslanian T, Verdier R (2017) How is patella height modified after total knee arthroplasty? Int Orthop. https://doi.org/10.1007/s00264-017-3539-6
- 36.Iwano T, Kurosawa H, Tokuyama H, Hoshikawa Y (1990) Roentgenographic and clinical findings of patellofemoral osteoarthrosis. With special reference to its relationship to femorotibial osteoarthrosis and etiologic factors. Clin Orthop Relat Res 252:190–197Google Scholar
- 41.Saffarini M, Demey G, Nover L, Dejour D (2016) Evolution of trochlear compartment geometry in total knee arthroplasty. Ann Transl Med 4:7. https://doi.org/10.3978/j.issn.2305-5839.2015.12.53 CrossRefPubMedPubMedCentralGoogle Scholar