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Patella non-resurfacing in primary total knee arthroplasty provides good functional results—a retrospective review of nine thousand three hundred forty six knees

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A Letter to the Editor to this article was published on 26 July 2023

Abstract

Purpose

Patellar resurfacing has long been a contentious subject in TKA with no consensus and the literature yielding disparate results. The aim of this study was to evaluate the long-term functional outcomes and complications of patients undergoing primary TKA without patellar resurfacing (non-resurfacing).

Methods

This study retrospectively analysed 9346 patients who underwent primary manual jig-based TKA without patellar resurfacing at a single high-volume arthroplasty centre between 2010 and 2018. Patients with a minimum three year follow-up irrespective of disease etiology and implant manufacturer were included in the study. Primary outcome was measured using Oxford knee score and patellofemoral Feller score. Secondary outcomes included determining the incidence of patellofemoral complications and re-operation rates following TKA.

Results

A total of 8695 knees were eligible for final evaluation having a mean follow-up of 6.6 years. Mean age of the patients was 62.6 (SD-7.5) years with female predominance of (N-6619, 70.8%). The majority of the patients had primary OA (N-8792, 94.1%) with varus deformity (N-8642, 92.46%). Depuy was the most used manufacturer (n = 2592, 26.4%) with the posterior stabilised (N-4127, 44.2%) design being the most predominant. The mean Feller score of the study population was 24.5 (SD = 3) with a majority of patients having good to excellent outcomes (86.95%, N-8424) and mean Oxford knee score was 36.9 (SD-6.9) with a majority of the patients having an OKS greater than 30 (87.1%, N-8133) with anterior knee pain (AKP) reported in only 4.8% patients (N-418). Most common complications included patellar clunk (N-56, 0.7%), traumatic patellar fractures (N-62, 0.8%), quadriceps tendon tear (N-54, 0.7%) and patellar dislocation (N-4, 0.05%)

Conclusion

Patellar non-resurfacing has no detrimental impact on functional outcomes and incidence of AKP. We conclude that it is a safe, cost-effective and satisfactory approach in primary TKA with no significant complications.

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References

  1. Scott WN, Rubinstein M, Scuderi G (1988) Results after knee replacement with a posterior cruciate-substituting prosthesis. J Bone Joint Surg Am 70:1163–1173

    Article  CAS  PubMed  Google Scholar 

  2. Anderson JG, Wixson RL, Tsai D et al (1996) Functional outcome and patient satisfaction in total knee patients over the age of 75. J Arthroplasty 11:831–840. https://doi.org/10.1016/S0883-5403(96)80183-5

    Article  CAS  PubMed  Google Scholar 

  3. Noble PC, Conditt MA, Cook KF, Mathis KB (2006) The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 452:35–43. https://doi.org/10.1097/01.BLO.0000238825.63648.1E

    Article  PubMed  Google Scholar 

  4. Heck DA, Robinson RL, Partridge CM et al (1998) Patient outcomes after knee replacement. Clin Orthop Relat Res 356:93–110. https://doi.org/10.1097/00003086-199811000-00015

    Article  Google Scholar 

  5. Dunbar MJ, Robertsson O, Ryd L, Lidgren L (2001) Appropriate questionnaires for knee arthroplasty. Results of a survey of 3600 patients from The Swedish Knee Arthroplasty Registry. J Bone Joint Surg Br 83:339–344. https://doi.org/10.1302/0301-620X.83B3.11134

    Article  CAS  PubMed  Google Scholar 

  6. Bourne RB, Chesworth BM, Davis AM et al (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57. https://doi.org/10.1007/S11999-009-1119-9

    Article  PubMed  Google Scholar 

  7. Patel K, Raut V (2011) Patella in total knee arthroplasty: to resurface or not to--a cohort study of staged bilateral total knee arthroplasty. Int Orthop 35:349–353. https://doi.org/10.1007/S00264-010-1063-Z

    Article  PubMed  Google Scholar 

  8. Barrack RL, Wolfe MW (2000) Patellar resurfacing in total knee arthroplasty. J Am Acad Orthop Surg 8:75–82. https://doi.org/10.5435/00124635-200003000-00001

    Article  CAS  PubMed  Google Scholar 

  9. Badhe N, Dewnany G, Livesley PJ (2001) Should the patella be replaced in total knee replacement? Int Orthop 25:97–99. https://doi.org/10.1007/S002640100225

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Abdel MP, Parratte S, Budhiparama NC (2014) The patella in total knee arthroplasty: to resurface or not is the question. Curr Rev Musculoskelet Med 7:117–124. https://doi.org/10.1007/s12178-014-9212-4

    Article  PubMed  PubMed Central  Google Scholar 

  11. Parsons T, Al-Jabri T, Clement ND et al (2021) Patella resurfacing during total knee arthroplasty is cost-effective and has lower re-operation rates compared to non-resurfacing. J Orthop Surg Res 16:1–9. https://doi.org/10.1186/s13018-021-02295-8

    Article  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. Breeman S, Campbell M, Dakin H et al (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

    Article  PubMed  Google Scholar 

  14. Oh IS, Kim MK, You DS et al (2006) Total knee arthroplasty without patellar resurfacing. Int Orthop 30:415–419. https://doi.org/10.1007/s00264-006-0111-1

    Article  PubMed  PubMed Central  Google Scholar 

  15. Nizard RS, Biau D, Porcher R et al (2005) A meta-analysis of patellar replacement in total knee arthroplasty. Clin Orthop Relat Res 432:196–203. https://doi.org/10.1097/01.blo.0000150348.17123.7f

    Article  Google Scholar 

  16. Burnett RS, Haydon CM, Rorabeck CH, Bourne RB (2004) Patella resurfacing versus nonresurfacing in total knee arthroplasty: results of a randomized controlled clinical trial at a minimum of 10 years’ followup. Clin Orthop Relat Res 428:12–25

    Article  Google Scholar 

  17. Fern ED, Winson IG, Getty CJM (1992) Anterior knee pain in rheumatoid patients after total knee replacement. Possible selection criteria for patellar resurfacing. J Bone Joint Surg Br 74:745–748. https://doi.org/10.1302/0301-620X.74B5.1527126

    Article  CAS  PubMed  Google Scholar 

  18. Whiteside LA, Nakamura T (2003) Effect of femoral component design on unresurfaced patellas in knee arthroplasty. Clin Orthop Relat Res 410:189–198. https://doi.org/10.1097/01.BLO.0000063605.67412.4D

    Article  Google Scholar 

  19. Trevino RL, Stoia J, Laurent MP et al (2017) Establishing a live cartilage-on-cartilage interface for tribological testing. Biotribology (Oxf) 9:1. https://doi.org/10.1016/J.BIOTRI.2016.11.002

    Article  PubMed  Google Scholar 

  20. Oungoulian SR, Durney KM, Jones BK et al (2015) Wear and damage of articular cartilage with friction against orthopedic implant materials. J Biomech 48:1957–1964. https://doi.org/10.1016/J.JBIOMECH.2015.04.008

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sato D, Inoue M, Sasaki T et al (2021) No patella resurfacing total knee arthroplasty leads to reduction in the thickness of patellar cartilage to less than half within 5 years: a quantitative longitudinal evaluation using MRI. J Exp Orthop 8:1–10. https://doi.org/10.1186/S40634-021-00425-Z/FIGURES/5

    Article  Google Scholar 

  22. Soudry M, Mestriner LA, Binazzi R, Insall JN (1986) Total knee arthroplasty without patellar resurfacing. Clin Orthop Relat Res:166–170

  23. Ali A, Lindstrand A, Nilsdotter A, Sundberg M (2016) Similar patient-reported outcomes and performance after total knee arthroplasty with or without patellar resurfacing: a randomized study of 74 patients with 6 years of follow-up. Acta Orthop 87:274–279. https://doi.org/10.3109/17453674.2016.1170548

    Article  PubMed  PubMed Central  Google Scholar 

  24. Agarwala S, Shetty V, Karumuri LK, Vijayvargiya M (2018) Patellar resurfacing versus nonresurfacing with patellaplasty in total knee arthroplasty. Indian J Orthop 52:393. https://doi.org/10.4103/ORTHO.IJORTHO_512_16

    Article  PubMed  PubMed Central  Google Scholar 

  25. 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

    Article  CAS  PubMed  Google Scholar 

  26. Chen K, Dai X, Li L et al (2021) Patellar resurfacing versus nonresurfacing in total knee arthroplasty: an updated meta-analysis of randomized controlled trials. J Orthop Surg Res 16:1–16. https://doi.org/10.1186/s13018-020-02185-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Tharani R, Nakasone C, Vince KG (2005) Periprosthetic fractures after total knee arthroplasty. J Arthroplasty 20:27–32. https://doi.org/10.1016/j.arth.2005.03.009

    Article  PubMed  Google Scholar 

  28. Chalidis BE, Tsiridis E, Tragas AA et al (2007) Management of periprosthetic patellar fractures: a systematic review of literature. Injury 38:714–724. https://doi.org/10.1016/J.INJURY.2007.02.054

    Article  PubMed  Google Scholar 

  29. Goldberg VM, Figgie HE 3rd, Inglis AE et al (1988) Patellar fracture type and prognosis in condylar total knee arthroplasty. Clin Orthop Relat Res:115–122

  30. Aglietti P, Baldini A, Buzzi R, Indelli PF (2001) Patella resurfacing in total knee replacement: functional evaluation and complications. Knee Surg Sports Traumatol Arthrosc 9(Suppl 1). https://doi.org/10.1007/S001670000160

  31. Shillington M, Farmer G (2012) Patellofemoral crepitus following LCS RPS total knee arthroplasty without patella resurfacing. Orthop Proceeding 94:19

    Google Scholar 

  32. Ogawa H, Matsumoto K, Akiyama H (2016) Effect of patellar resurfacing on patellofemoral crepitus in posterior-stabilized total knee arthroplasty. J Arthroplasty 31:1792–1796. https://doi.org/10.1016/J.ARTH.2016.01.023

    Article  PubMed  Google Scholar 

  33. Sequeira SB, Scott J, Novicoff W, Cui Q (2020) Systematic review of the etiology behind patellar clunk syndrome. World J Orthop 11:184. https://doi.org/10.5312/WJO.V11.I3.184

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India

    Adarsh Annapareddy, Praharsha Mulpur, Tarun Jayakumar, Rajeev Reddy Kikkuri, A. B. Suhas Masilamani, Ratnakar V. & A. V. Gurava Reddy

  2. Indraprastha Apollo Hospitals, New Delhi, India

    Raju Vaishya

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  1. Adarsh Annapareddy
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Contributions

1. A. A.: conceptualization; writing—review and editing

2. P. M.: methodology; writing—review and editing

3. T. J.: writing—original draft; investigation; formal analysis

4. R. R. K.: writing—original draft; investigation

5. A. B. S. M.: writing—review and editing

6. R. V.: writing—review and editing

7. R. V.: writing—review and editing

8. A. V. G. R.: conceptualization; data curation; writing—review and editing

Corresponding author

Correspondence to Tarun Jayakumar.

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Annapareddy, A., Mulpur, P., Jayakumar, T. et al. Patella non-resurfacing in primary total knee arthroplasty provides good functional results—a retrospective review of nine thousand three hundred forty six knees. International Orthopaedics (SICOT) 47, 1729–1736 (2023). https://doi.org/10.1007/s00264-023-05819-5

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