Patellar Resurfacing Does Not Improve Clinical Outcome in Patients with Symptomatic Tricompartmental Knee Osteoarthritis. An RCT Study of 40 Patients Receiving Primary Cruciate Retaining Total Knee Arthroplasty

Abstract

There is some evidence that patellofemoral (PF) joint osteoarthritis (OA) causes anterior knee pain (AKP) after total knee arthroplasty (TKA). We hypothesized that patellar resurfacing in primary TKA for patients with symptomatic tricompartmental knee OA yields better clinical results after 2 years than non-resurfacing. A single center randomized controlled clinical trial comparing 40 patients receiving 42 cruciate retaining TKAs with (n = 21) or without patellar resurfacing (n = 21) was conducted. Primary outcome was the specific PF joint score HSS Baldini and secondary outcomes were the Knee Society Score (KSS) and the Knee Osteoarthritis Outcome Scale (KOOS). After 2 years no significant differences between both groups and between the groups in time for HSS Baldini, KSS, and KOOS were found. HSS Baldini score improved significantly after 6 weeks in both groups (p < 0.001) and did not improve in time afterward. At final follow-up the HSS Baldini mean score improved from a preoperative mean of 39 to 88 (difference of 49 points; p < 0.001)) for without patellar resurfacing group, and from a preoperative mean of 37 to 81 for patellar resurfacing group (difference of 47 points; p < 0.001). One patient in the patellar resurfacing group underwent a soft tissue re-alignment procedure because of patellar subluxation. Two patients in without patellar resurfacing group received secondary patellar button placement. Patellar resurfacing in primary TKA for patients with symptomatic tricompartmental OA has no beneficial effect over non-resurfacing and seems unnecessary. A special PF joint outcome measurement tool (HSS Baldini) and common knee scores showed no better knee function or AKP outcomes for with patellar resurfacing over without patellar resurfacing group in time and after 2 years of follow-up.

Clinical effectiveness of patellar resurfacing, no resurfacing and selective resurfacing in primary total knee replacement: systematic review and meta-analysis of interventional and observational evidence

“…The mean follow-up periods in the trials ranged from 0.5 to 10 years with a weighted mean of 6.3 years. Using the Cochrane Risk of Bias tool, 11 trials demonstrated a low risk of bias in all domains [ 30 , 34 , 39 , 42 , 48 , 51 – 54 , 57 , 58 ]. Five trials demonstrated a high risk of bias in one or more domains [ 1 , 31 , 38 , 40 , 45 ].…”

“…There was no significant difference in the risk of reoperation (15 studies) [ 1 , 29 , 35 , 37 – 39 , 44 – 46 , 50 , 53 , 55 – 58 ] comparing patellar resurfacing vs. no resurfacing: RR (CIs) = 0.70 (0.44–1.13; I 2 = 0%; CI = 0–54%; p for heterogeneity = 0.87); however patellar resurfacing reduced the risk of revision (17 studies) [ 19 , 31 , 33 , 39 , 40 , 42 , 44 , 47 , 51 – 58 ]: RR (CIs) = 0.63 (0.42–0.94; I 2 = 0%; CI = 0–51%; p for heterogeneity = 0.95) (Fig. 3 ).…”

Rare primary patellar resurfacing does not lead to more secondary patellar resurfacing: analysis of 70,014 primary total knee arthroplasties in the Dutch Arthroplasty Register (LROI)

“…Second, the registry does not include clinical symptoms like anterior knee pain, patellar osteoarthritis, or other specific details of the patella. The presence of osteoarthritis of the patella may influence the decision to perform primary patellar resurfacing, although some authors find that this presence does not influence the outcome of the resurfacing ( 8 , 29 ). Third, the registry registers the rate only of patellar resurfacing of hospitals, not of individual surgeons.…”

“…Current literature remains controversial as it provides no conclusive evidence in support of a patellar resurfacing vs. non-resurfacing regime ( 5 , 8 , 9 ). A meta-analysis showed that the number of revision surgeries was lower following TKA with patellar resurfacing than without ( 10 ).…”

Does the degree of intraoperatively identified cartilage loss affect the outcomes of primary total knee arthroplasty without patella resurfacing? A prospective comparative cohort study

“…Moreover, there is a lack of evidence that patellar cartilage loss identified during TKA causes anterior knee pain or decreased function [ 6 ]. Some studies have reported that there were no differences in outcomes between patients who underwent or did not undergo patellar resurfacing, regardless of the degree of patellar cartilage loss [ 7 – 9 ]. The authors of one study reported satisfactory radiologic outcomes with patellar retention in patients with grade 4 advanced osteoarthritis (OA) in the patellofemoral joint [ 10 ].…”