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Evidence-Based Orthopaedics   |    
Patellar Resurfacing in Primary Total Knee ReplacementA Meta-Analysis
R.W.D. Pilling, MRCS1; E. Moulder, FRCS(Orth)2; V. Allgar, BSc(Hons), CStat, PhD3; J. Messner, MRCS(Orth)4; Z. Sun, MRCS4; A. Mohsen, FRCS(Orth), PhD2
1 Department of Orthopaedics, University Hospital of North Staffordshire, Newcastle Road, Stoke on Trent ST4 6QG, United Kingdom. E-mail address: rich_pilling@yahoo.co.uk
2 Department of Orthopaedics, Hull and East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, Analby Road, Hull HU3 2JZ, United Kingdom
3 Hull York Medical School, University of York, Heslington, York YO10 5DD, United Kingdom
4 Yorkshire and the Humber Postgraduate Deanery, University of Leeds, Willow Terrace Road, Leeds LS2 9JT, United Kingdom
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Investigation performed at Hull Royal Infirmary, Hull, United Kingdom



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Dec 19;94(24):2270-2278. doi: 10.2106/JBJS.K.01257
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Abstract

Background: 

Treatment of the patella during total knee replacement is an area of continuing debate. We performed a meta-analysis of randomized controlled trials to address the hypothesis that patellar resurfacing in primary total knee replacement improved patient outcome.

Methods: 

Randomized controlled trials comparing patellar resurfacing with nonresurfacing in primary total knee replacement were included. The primary outcomes analyzed were knee scores, anterior knee pain, and patient satisfaction. We also investigated the prevalence of complications, revision surgery related specifically to the patellofemoral joint, the infection rate, operative time, and radiographic appearance.

Results: 

Sixteen randomized controlled trials assessing 3465 knee replacements were eligible; 1710 procedures included patellar resurfacing and 1755 did not. The knee component of the Knee Society Score was significantly higher in the resurfacing group (p = 0.005); however, no significant difference was observed for the function component of the Knee Society Score or for any other reported knee score. Anterior knee pain was reported in 13% of resurfaced knees and in 24% of nonresurfaced knees; this difference was not significant (p = 0.1). Patients were satisfied with the outcome after 485 (90%) of 539 procedures that included patellar resurfacing compared with 488 (89%) of 548 that did not; this difference was not significant. There were ninety-three reported patellofemoral complications in the resurfacing group and 205 in the nonresurfacing group; this difference was significant (p = 0.02) in a random-effect model. The rate of reoperation because of anterior knee pain (p < 0.00001) and the rate of reoperation because of any patellofemoral complication (p = 0.002) were significantly higher in the nonresurfaced group. No differences were found in the analyses of infection rate, operative time, or radiographic appearance.

Conclusions: 

Patients who underwent patellar resurfacing experienced anterior knee pain and satisfaction with the arthroplasty procedure that were equivalent to those experienced by patients whose patella was not resurfaced; however, these patients underwent significantly fewer additional surgical procedures. Further long-term follow-up of modern prostheses in randomized studies measuring outcome with a patella-specific score is needed.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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