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Resurfacing versus nonresurfacing the patella in total knee arthroplasty: a critical appraisal of the available evidence

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Abstract

A systematic literature search for evidences comparing treatment effect and harm of resurfacing versus nonresurfacing the patella in total knee arthroplasty was conducted and yielded five meta-analysis (MA), one systematic review (SR) and six randomized controlled trials not included in previous MAs/SR. The evidence suggests that patellar resurfacing would reduce the risk of anterior knee pain, as well as the risk of patella-related reoperation. Furthermore, patients not undergoing patella resurfacing would experience more knee pain during stair climbing and be less satisfied with surgery. No significant difference in range of motion can be expected with or without patellar resurfacing. Importantly, methodological limitations were observed in all retrieved studies and evidences about potential adverse events related to patellar resurfacing are presently undetermined.

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References

  1. Swedish Knee Arthroplasty Register. Annual Report 2004 Part I and Part II. http://www.ort.lu.se/knee/pdf/skar2004engl.pdf

  2. Burnett RS, Bourne RB (2003) Indications for patellar resurfacing in total knee arthroplasty. J Bone Joint Surg Am 85(4):728–745

    Google Scholar 

  3. Guyatt G, Rennie D (2002) User’s guide to the medical literature. A manual for evidence-based clinical practice. AMA Press, Chicago

    Google Scholar 

  4. Cochrane handbook for systematic reviews of interventions (ver. 4.2.6, September 2006). http://www.cochrane.org/resources/handbook/handbook.pdf

  5. Lau J, Ioannidis JP, Schmid CH (1997) Quantitative synthesis in systematic reviews. Ann Intern Med 127(9):820–826

    PubMed  CAS  Google Scholar 

  6. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558

    Article  PubMed  Google Scholar 

  7. Montori VM, Swiontkowski MF, Cook DJ (2003) Methodological issues in systematic reviews and meta-analyses. Clin Orthop Relat Res 413:43–54

    Article  PubMed  Google Scholar 

  8. Forster MC (2004) Patellar resurfacing in total knee arthroplasty for osteoarthritis: a systematic review. Knee 11(6):427–430

    Article  PubMed  CAS  Google Scholar 

  9. Leon-Hernandez SR, Aguilera-Zepeda M, Luna-Hernandez JA (1999) Complicaciones patelares en la artroplastia total de rodilla: un studio de metanalisis. Gac Med Mex 135(4):373–381

    PubMed  CAS  Google Scholar 

  10. Bourne RB, Burnett RS (2004) The consequences of not resurfacing the patella. Clin Orthop Relat Res 428:166–169

    Article  PubMed  Google Scholar 

  11. 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

    Article  PubMed  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(7):1438–1445

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  15. Campbell DG, Duncan WW, Ashworth M, Mintz A, Stirling J, Wakefield L, Stevenson TM (2006) Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. J Bone Joint Surg Br 88(6):734–739

    Article  PubMed  CAS  Google Scholar 

  16. Smith AJ, Lloyd DG, Wood DJ (2006) A kinematic and kinetic analysis of walking after total knee arthroplasty with and without patellar resurfacing. Clin Biomech 21(4):379–386

    Article  Google Scholar 

  17. Myles CM, Rowe PJ, Nutton RW, Burnett R (2006) The effect of patellar resurfacing in total knee arthroplasty on functional range of movement measured by flexible electrogoniometry. Clin Biomech 21(7):733–739

    Article  Google Scholar 

  18. Burnett RS, Boone JL, McCarthy KP, Rosenzweig S, Barrack RL (2007) A prospective randomized clinical trial of patellar resurfacing and nonresurfacing in bilateral TKA. Clin Orthop Relat Res 464:65–72

    PubMed  CAS  Google Scholar 

  19. Smith AJ, Wood DJ, Li MG (2008) Total knee replacement with and without patellar resurfacing. A prospective randomised trial using the Profix knee system. J Bone Joint Surg Br 90(1):43–49

    PubMed  CAS  Google Scholar 

  20. Andersen HN, Ernst C, Frandsen PA (1991) Polyethylene failure of metal-backed patellar components: 111 AGC total knees followed for 7–22 months. Acta Orthop Scand 62(1):1–3

    PubMed  CAS  Google Scholar 

  21. Baech J, Kofoed A (1991) Failure of metal-backed patellar arthroplasty: 47 AGC total knees followed for at least 1 year. Acta Orthop Scand 62(2):166–168

    PubMed  CAS  Google Scholar 

  22. Johnson DP, Eastwood DM (1992) Patellar complications after knee arthroplasty. A prospective study of 56 cases with the kinematic prosthesis. Acta Orthop Scand 63(1):74–79

    Article  PubMed  CAS  Google Scholar 

  23. Berry DJ, Rand J (1993) Isolated patellar component revision of total knee arthroplasty. Clin Orthop Relat Res 286:110–115

    PubMed  Google Scholar 

  24. Levitsky KA, Harris WJ, McManus J, Scott RD (1993) Total knee arthroplasty without patellar resurfacing: clinical outcomes and long-term follow-up evaluation. Clin Orthop Relat Res 286:116–121

    PubMed  Google Scholar 

  25. Levi N, Kofoed H (1994) Early failure of metal-backed patellar arthroplasty. J Bone Joint Surg Br 76-B(4):675

    Google Scholar 

  26. Fernandez Medina JM, Vilaseca Aguera MA, Queipo de Llano A (1994) Complicaciones del aparato extensor en protesis total de rodilla. Rev Ortop Traumatol 6:454–458

    Google Scholar 

  27. Luna HA (1997) Complicaciones patelares en la artroplastia total de rodilla. Thesis. Instituto Nacional de Ortopedia, Mexico

    Google Scholar 

  28. Enis JE, Gardner R, Robledo MA, Latta L, Smith R (1990) Comparison of patellar resurfacing versus nonresurfacing in bilateral total knee arthroplasty. Clin Orthop Relat Res 260:38–42

    PubMed  Google Scholar 

  29. Newman JH, Ackroyd CE, Shah NA, Karachalios T (2000) Should the patella be resurfaced during total knee replacement? Knee 7(1):17–23

    Article  Google Scholar 

  30. Barrack RL, Bertot AJ, Wolfe MW, Waldman DA, Milicic M, Myers L (2001) Resurfacing of the patella in total knee arthroplasty: a prospective, randomised, double blind study with five to seven years of follow-up. J Bone Joint Surg Am 83(9):1376–1381

    PubMed  Google Scholar 

  31. Mayman D, Bourne RB, Rorabeck CH, Vaz M, Kramer J (2003) Resurfacing versus not resurfacing the patella in total knee arthroplasty: 8- to 10-year results. J Arthroplasty 18(5):541–545

    Article  PubMed  Google Scholar 

  32. Levai JP, McLeod HC, Freeman MA (1983) Why not resurface the patella? J Bone Joint Surg Br 65(4):448–451

    PubMed  CAS  Google Scholar 

  33. Keblish PA, Varma AK, Greenwald AS (1994) Patellar resurfacing or retention in total knee arthroplasty: a prospective study of patients with bilateral replacements. J Bone Joint Surg Br 76(6):930–937

    PubMed  CAS  Google Scholar 

  34. Bourne RB, Rorabeck CH, Vaz M, Kramer J, Hardie R, Robertson D (1995) Resurfacing versus not resurfacing the patella during total knee replacement. Clin Orthop Relat Res 321:156–161

    PubMed  Google Scholar 

  35. Nicolay X (1995) Faut-il resurfacer la rotule dans les protheses totales de genou? Resultats préliminaires d’une série prospective de 100 arthroplasties. Service de Chirurgie Orthopédique et Traumatologique. Nancy, Faculté de Médecine de Nancy 205

  36. Partio E, Wirta J (1995) Comparison of patellar resurfacing and nonresurfacing in total knee arthroplasty: a prospective randomised study. J Orthop Rheum 8:69–74

    Google Scholar 

  37. Feller JA, Bartlett RJ, Lang DM (1996) Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br 78(2):226–228

    PubMed  CAS  Google Scholar 

  38. Kajino A, Yoshino S, Kameyama S, Kohda M, Nagashima S (1997) Comparison of the results of bilateral total knee arthroplasty with and without patellar replacement for rheumatoid arthritis: a follow-up note. J Bone Joint Surg Am 79(4):570–574

    Article  PubMed  CAS  Google Scholar 

  39. Schroeder-Boersch H, Scheller G, Fischer J, Jani L (1998) Advantages of patellar resurfacing in total knee arthroplasty: two-years results of a prospective randomized study. Arch Orthop Trauma Surg 117(1–2):73–78

    Article  PubMed  CAS  Google Scholar 

  40. Wood DJ, Smith AJ, Collopy D, White B, Brankov B, Bulsara MK (2002) Patellar resurfacing in total knee arthroplasty: a prospective, randomized trial. J Bone Joint Surg Am 84(2):187–193

    PubMed  Google Scholar 

  41. Waters TS, Bentley G (2003) Patellar resurfacing in total knee arthroplasty: a prospective randomized trial. J Bone Joint Surg Am 85(2):212–217

    PubMed  Google Scholar 

  42. Waikakul S, Vanadurongwan V, Bintachitt B (2000) The effects of patellar resurfacing in total knee arthroplasty on position sense: a prospective randomized study. J Med Assoc Thai 83(9):975–982

    PubMed  CAS  Google Scholar 

  43. Kordelle J, Schleicher I, Kaltschmidt I, Haas H, Gruner MR (2003) Patella resurfacing in patients without substantial retropatellar knee pain symptoms. Z Orthop Ihre Grenzgeb 141(5):557–562

    Article  PubMed  CAS  Google Scholar 

  44. Abraham W, Buchanan JR, Daubert H, Greer RB 3rd, Keefer J (1988) Should the patella be resurfaced in total knee arthroplasty? Efficacy of patellar resurfacing. Clin Orthop Relat Res 236:128–134

    PubMed  Google Scholar 

  45. Pollo FE, Jackson RW, Koeter S, Ansari S, Motley GS, Rathjen KW (2000) Walking, chair rising, and stair climbing after total knee arthroplasty: patellar resurfacing versus nonresurfacing. Am J Knee Surg 13(2):103–108

    PubMed  CAS  Google Scholar 

  46. Bhandari M, Guyatt GH, Swiontkowski MF (2001) Users’ guide to the orthopaedic literature: how to use an article about a surgical therapy. J Bone Joint Surg Am 83(6):916–926

    Article  PubMed  Google Scholar 

  47. Altman DG, Bland JM (1999) Statistics notes: how to randomise. BMJ 319(7211):703–704

    PubMed  CAS  Google Scholar 

  48. Altman DG, Schulz KF (2001) Statistics note: concealing treatment allocation in randomised controlled trials. BMJ 323(7310):446–447

    Article  PubMed  CAS  Google Scholar 

  49. Day SJ, Altman DG (2000) Statistics notes: blinding in clinical trials and other studies. BMJ 321(7259):504

    Article  PubMed  CAS  Google Scholar 

  50. Campbell MJ, Julious SA, Altman DG (1995) Estimating sample size for binary, ordered categorical, and continuous outcomes in two group comparison. BMJ 311(7013):1145–1148

    PubMed  CAS  Google Scholar 

  51. Devereaux PJ, McKee MD, Yusuf S (2003) Methodological issues in randomized controlled trials of surgical intervention. Clin Orthop Relat Res 413:25–32

    Article  PubMed  Google Scholar 

  52. McCulloch P, Taylor I, Sasako M, Lovett B, Griffin D (2002) Randomised trials in surgery: problems and possible solutions. BMJ 324(7351):1448–1451

    Article  PubMed  Google Scholar 

  53. Bhandari M, Guyatt GH, Montori VM, Devereaux PJ, Swiontkowski MF (2002) Users’ guide to the orthopaedic literature: how to use a systematic literature review. J Bone Joint Surg Am 84(9):1672–1682

    PubMed  Google Scholar 

  54. Jüni P, Altman DG, Egger M (2001) Systematic reviews in healthcare: assessing the quality of controlled clinical trials. BMJ 323(7303):42–46

    Article  PubMed  Google Scholar 

  55. Bhandari M, Morrow F, Kulkarni AV, Tornetta P 3rd (2001) Meta-analyses in orthopaedic surgery: a systematic review of their methodologies. J Bone Joint Surg Am 83(1):15–24

    Article  PubMed  Google Scholar 

  56. Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed  Google Scholar 

  57. Hopayian K (2001) The need for caution in interpreting high quality systematic reviews. BMJ 323(7314):681–684

    Article  PubMed  CAS  Google Scholar 

  58. Poolman RW, Abouali JAK, Conter HJ, Bhandari M (2007) Overlapping systematic reviews of anterior cruciate ligament reconstruction comparing hamstring autograft with bone-patellar tendon-bone autograft: why are they different? J Bone Joint Surg Am 89(7):1542–1552

    Article  PubMed  Google Scholar 

  59. Jadad AR, Cook DJ, Brownman GP (1997) A guide to interpreting discordant systematic reviews. CMAJ 156(10):1411–1416

    PubMed  CAS  Google Scholar 

  60. Chan AW, Altman DG (2005) Identifying outcome reporting bias in randomised trials on PubMed: review of publications and survey of authors. BMJ 330(7494):753

    Article  PubMed  Google Scholar 

  61. Anouchi YS, Whiteside LA, Kaiser AD, Milliano MT (1993) The effects of axial rotational alignment of the femoral component on knee stability and patellar tracking in total knee arthroplasty demonstrated on autopsy specimens. Clin Orthop Relat Res 287:170–177

    PubMed  Google Scholar 

  62. Akagi M, Matsusue Y, Mata T, Asada Y, Horiguchi M, Iida H, Nakamura T (1999) Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res 366:155–163

    Article  PubMed  Google Scholar 

  63. Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A (2005) Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res 433:152–159

    Article  PubMed  Google Scholar 

  64. Anderson KC, Buehler KC, Markel DC (2005) Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 20(7 Suppl 3):132–138

    Article  PubMed  Google Scholar 

  65. Whiteside LA, Nakamura T (2003) Effect of femoral component design on unresurfaced patellas in knee arthroplasty. Clin Orthop Relat Res 410:189–198

    Article  PubMed  Google Scholar 

  66. Oxman AD, Guyatt GH (1991) Validation of an index of the quality of review articles. J Clin Epidemiol 44(11):1271–1278

    Article  PubMed  CAS  Google Scholar 

  67. Petticrew M (2003) Why certain systematic reviews reach uncertain conclusions. BMJ 326(7392):756–758

    Article  PubMed  Google Scholar 

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Acknowledgment

The authors of the present study wish to thank Dr. John B. Meding from the Joint Replacement Surgeons of Indiana Research Foundation, USA, for his valuable encouragement, support and wise suggestions during the different phases of preparation of the manuscript.

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No competing interests.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of L’Aquila, Viale S. Salvatore, Edificio Delta 6, 67010, Coppito (AQ), L’Aquila, Italy

    Vittorio Calvisi, Gianluca Camillieri & Stefano Lupparelli

  2. Care UK, Peninsula NHS Treatment Centre, Plymouth, UK

    Stefano Lupparelli

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  1. Vittorio Calvisi
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  2. Gianluca Camillieri
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  3. Stefano Lupparelli
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Correspondence to Vittorio Calvisi.

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Calvisi, V., Camillieri, G. & Lupparelli, S. Resurfacing versus nonresurfacing the patella in total knee arthroplasty: a critical appraisal of the available evidence. Arch Orthop Trauma Surg 129, 1261–1270 (2009). https://doi.org/10.1007/s00402-008-0801-9

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