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Patellar Resurfacing in Total Knee Arthroplasty A Prospective, Randomized, Double-Blind Study with Five to Seven Years of Follow-up
Robert L. Barrack, MD; Alexander J. Bertot, MD; Michael W. Wolfe, MD; Douglas A. Waldman, MD; Matko Milicic, MD; Leann Myers, PhD
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Investigation performed at Tulane University School of Medicine, New Orleans, Louisiana
Robert L. Barrack, MD
Alexander J. Bertot, MD
Michael W. Wolfe, MD
Department of Orthopaedic Surgery, SL-32, Tulane University School of Medicine, New Orleans, LA 70112. E-mail address for R.L. Barrack: rbarrack@tulane.edu

Douglas A. Waldman, MD
Orthopaedic Surgery Section, Surgical Service, Veterans Affairs Medical Center, Shreveport Highway, Alexandria, LA 71302

Matko Milicic, MD
Orthopaedic Surgery Section, Surgical Service, Veterans Affairs Medical Center, 1601 Perdido Street, New Orleans, LA 70146

Leann Myers, PhD
Department of Biostatistics and Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112

In support of their research or preparation of this manuscript, one or more of the authors received research funding from Zimmer, Incorporated. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our CD-ROM (call 781-449-9780, ext. 140, to order).

J Bone Joint Surg Am, 2001 Sep 01;83(9):1376-1381
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Background: Whether to resurface the patella during a primary total knee arthroplasty performed for the treatment of degenerative osteoarthritis remains a controversial issue. Parameters that have been suggested as being useful in guiding this decision include patient height and weight, the presence of anterior knee pain preoperatively, and the grade of chondromalacia encountered intraoperatively. The purpose of this study was to determine whether these parameters were predictive of the clinical result following total knee arthroplasty with or without patellar resurfacing.

Methods: Eighty-six patients (118 knees) undergoing primary total knee arthroplasty for the treatment of osteoarthritis were enrolled in a prospective, randomized, double-blind study. All patients received the same posterior-cruciate-sparing total knee prosthetic components. Patients were randomized to treatment with or without resurfacing of the patella. Evaluations consisted of the determination of a Knee Society clinical score, the completion of a patient satisfaction questionnaire, specific questions relating to patellofemoral symptoms, and radiographs. Sixty-seven patients (ninety-three knees) were followed for a minimum of five years (range, sixty to eighty-four months; average, 70.5 months).

Results: With the numbers available, there was no significant difference between the groups treated with and without resurfacing with regard to the overall Knee Society score or the pain and function subscores. Obesity, the degree of patellar chondromalacia, and the presence of preoperative anterior knee pain did not predict postoperative clinical scores or the presence of postoperative anterior knee pain.

Conclusions: The occurrence of anterior knee pain could not be predicted with any clinical or radiographic parameter studied. On the basis of these results, it seems likely that postoperative anterior knee pain is related either to the component design or to the details of the surgical technique, such as component rotation, rather than to whether or not the patella is resurfaced.

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    Accreditation Statement
    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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