Instructional Course Lecture   |    
Indications for Patellar Resurfacing in Total Knee Arthroplasty
R. Stephen Burnett, MD; Robert B. Bourne, MD
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An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

R. Stephen Burnett, MD
Robert B. Bourne, MD
Division of Orthopaedic Surgery, London Health Sciences Centre, University Campus, London, ON N6A 5A5, Canada. E-mail address for R.B. Bourne: robert.bourne@lhsc.on.ca

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive 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.

Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2004 in Instructional Course Lectures , Volume 53. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).

J Bone Joint Surg Am, 2003 Apr 01;85(4):728-745
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The controversy about whether to resurface the patella or to leave the native patella unresurfaced continues to be debated by orthopaedic surgeons performing total knee arthroplasties 1 . When the original total knee prostheses were designed, the patellofemoral articulation was not taken into consideration as a potential source of pain, and the results were complicated by patellofemoral symptoms despite an otherwise well-performed knee arthroplasty. Subsequent designs incorporated a femoral flange for the patellofemoral articulation and provided the option for patellar resurfacing. These early implants were not designed to accommodate the native patella in an anatomic fashion during the range of motion, and resurfacing of the patella was recommended. Complications related to patellar resurfacing became a primary concern, however, and have been associated with the variable revision rates often reported after total knee arthroplasty. Subsequent modifications in implant design have been made to offer the surgeon the option of leaving the patella unresurfaced. Increased awareness of component orientation and rotation has also improved the results with regard to the patellofemoral articulation after total knee arthroplasty 2 . Numerous clinical trials have been done to help clarify the indications for patellar resurfacing. Unfortunately, there is little consensus, and surgeon preference remains the primary variable. Despite the numerous trials, there are three basic strategies: always resurface, never resurface, or selectively resurface the patella.
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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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