Total knee arthroplasty without patellar resurfacing

Oh, In Suk; Kim, Myung Ku; You, Dong Seok; Kang, Seok Bong; Lee, Kwan Hee

doi:10.1007/s00264-006-0111-1

Cited by 16 publications

(11 citation statements)

References 42 publications

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“…6 We did not find a correlation between the incidence of anterior knee pain and the extent of cartilage damage, which has been reported in other studies. 4,[32][33][34] We used the posterior-stabilised, fixed-bearing NexGen prosthesis in all patients. It has been suggested that a fixed design may be associated with a higher incidence of anterior knee pain than a mobile-bearing prosthesis.…”

Section: Discussionmentioning

confidence: 99%

A randomised, controlled trial of circumpatellar electrocautery in total knee replacement without patellar resurfacing

Jonbergen

Scholtes

Kampen

et al. 2011

The Journal of Bone and Joint Surgery. British volume

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The efficacy of circumpatellar electrocautery in reducing the incidence of post-operative anterior knee pain is unknown. We conducted a single-centre, outcome-assessor and patient-blinded, parallel-group, randomised, controlled trial to compare circumpatellar electrocautery with no electrocautery in total knee replacement in the absence of patellar resurfacing. Patients requiring knee replacement for primary osteoarthritis were randomly assigned circumpatellar electrocautery (intervention group) or no electrocautery (control group). The primary outcome measure was the incidence of anterior knee pain. A secondary measure was the standardised clinical and patient-reported outcomes determined by the American Knee Society scores and the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. A total of 131 knees received circumpatellar electrocautery and 131 had no electrocautery. The overall incidence of anterior knee pain at follow-up at one year was 26% (20% to 31%), with 19% (12% to 26%) in the intervention group and 32% (24% to 40%) in the control group (p = 0.02). The relative risk reduction from electrocautery was 40% (9% to 61%) and the number needed to treat was 7.7 (4.3 to 41.4). The intervention group had a better mean total WOMAC score at follow-up at one year compared with the control group (16.3 (0 to 77.7) versus 21.6 (0 to 76.7), p = 0.04). The mean post-operative American Knee Society knee scores and function scores were similar in the intervention and control groups (knee score: 92.4 (55 to 100) versus 90.4 (51 to 100), respectively (p = 0.14); function score: 86.5 (15 to 100) versus 84.5 (30 to 100), respectively (p = 0.49)). Our study suggests that in the absence of patellar resurfacing electrocautery around the margin of the patella improves the outcome of total knee replacement.

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Section: Discussionmentioning

confidence: 99%

A randomised, controlled trial of circumpatellar electrocautery in total knee replacement without patellar resurfacing

Jonbergen

Scholtes

Kampen

et al. 2011

The Journal of Bone and Joint Surgery. British volume

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“…Patellar complications, such as aseptic loosening and fracture, can occur at rates up to 5 and 12%, respectively [3,4,9,11,13,16,17,19]. Proposed aetiologies of these complications have been well delineated in the literature, including vascular, technical, biomechanical, thermal and traumatic [5,22,23].…”

Section: Introductionmentioning

confidence: 99%

Resection arthroplasty for failed patellar components

Lavernia

Alcerro²,

Drakeford³

et al. 2008

International Orthopaedics (SICOT)

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A total of 1,401 primary total knee arthroplasties (TKA) were reviewed; 44 (3.2%) had at least the patellar component revised. Nine of these knees (eight patients) had insufficient bone stock to allow reimplantation of another patellar component. Clinical data on the nine knees were obtained with recent follow-up evaluation, review of their medical records and radiographs. Evaluation included Hospital for Special Surgery (HSS) scores. Average follow-up was 4 years and 7 months, 2-year range (2 months to 8 years and 4 months). Common factors found in these nine knees included: thin patella after primary TKR status, osteoarthritis, good range of motion and patella alta. Results were good to excellent in seven knees and fair in two. The untoward associations with patellectomy such as quadriceps lag, extension weakness and anterior knee pain were not experienced. Resection of the patellar component, without reimplantation, is an acceptable alternative in revision TKA lacking adequate remaining bone stock.Résumé Objectif: Analyser les reprises des prothèses totales de genou avec ablation de l'insert rotulien. 1401 prothèses totales du genou ont été revues. 44 genoux (3,2%) ont eu une révision du composant rotulien. 9 de ces genoux (8 patients) n'avaient pas un stock osseux suffisant pour permettre une réimplantation d'une prothèse rotulienne. Méthodes: les données cliniques de ces 9 patients ont été analysées ainsi que leur suivi clinique et radiographique et une évaluation selon le score HSS. Résultats: le suivi moyen a été de 4 ans et 7 mois (de 2 mois à 8 ans, 4 mois). Ces malades présentaient en commun une épaisseur patellaire très mince après la prothèse primaire avec une bonne mobilité et une rotule haute. Les résultats ont été excellents et bons dans 7 cas et médiocres dans 2 cas. Nous n'avons pas évalué la force du quadriceps et les douleurs antérieures. En conclusion: l'ablation du composant patellaire sans réimplantation est une alternative acceptable dans les révisions de prothèses totales du genoux qui n'ont pas un stock osseux suffisant.

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“…Some authors recommend routinely resurfacing the patella [7][8][9][10][11], while others have reported no evidence to support routine patellar resurfacing. The patella complications were found more often in the resurfaced group than in the group without resurfacing [12][13][14][15][16]. Further authors suggested a selective decision based on factors such as the patella thickness, the presence of preoperative anterior knee pain, the severity of degenerative changes in the patella or rheumatoid arthritis and the experience of the surgeon [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Systematic review of patellar resurfacing in total knee arthroplasty

Chen

et al. 2010

International Orthopaedics (SICOT)

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Controversies existing over resurfacing the patella in total knee arthroplasty remain in the literature. The purpose of this review was to evaluate the effectiveness of resurfacing versus nonresurfacing the patella in total knee arthroplasty. We searched the Cochrane Library, MEDLINE and EMBASE for published randomised clinical trials relevant to patellar resurfacing. The relative risk of reoperation was significantly lower for the patellar resurfacing group than for the nonresurfacing group (relative risk 0.57, 95% confidence interval 0.38-0.84, P=0.004). The overall incidence of postoperative anterior knee pain of the 1,421 knees included was 12.9% in the patellar resurfacing group and 24.1% in the nonresurfacing group. The existing evidence indicates that patellar resurfacing can reduce the risk of reoperation with no improvement in postoperative knee function or patient satisfaction over total knee arthroplasty without patellar resurfacing. Whether it can decrease the incidence of anterior knee pain remains uncertain.

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Total knee arthroplasty without patellar resurfacing

Cited by 16 publications

References 42 publications

A randomised, controlled trial of circumpatellar electrocautery in total knee replacement without patellar resurfacing

A randomised, controlled trial of circumpatellar electrocautery in total knee replacement without patellar resurfacing

Resection arthroplasty for failed patellar components

Systematic review of patellar resurfacing in total knee arthroplasty

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