Background: Patellar resurfacing during total knee arthroplasty
remains controversial. We aimed to evaluate the effectiveness of this
technique through an evaluation of the current literature.
Methods: We performed a meta-analysis of randomized controlled
trials comparing total knee arthroplasties performed with and without patellar
resurfacing. Outcomes of interest included the number of reoperations, the
prevalence of postoperative anterior knee pain, and the improvement in various
Results: Ten trials assessing 1223 knees were eligible. The absolute
risk of reoperation was reduced by 4.6% (95% confidence interval, 1.9% to
7.3%) in the patellar resurfacing arm (between-study heterogeneity, p <
0.01; I2 = 60%), implying that one would have to resurface
twenty-two patellae (95% confidence interval, fourteen to fifty-two patellae)
in order to prevent one reoperation. Patellar resurfacing reduced the absolute
risk of postoperative anterior knee pain by 13.8% (95% confidence interval,
6.4% to 21.2%), implying that one would have to resurface seven patellae (95%
confidence interval, five to sixteen patellae) in order to prevent one case of
postoperative anterior knee pain. Only four trials provided adequate data for
a quantitative synthesis of the changes in the various knee scores; on the
basis of those four trials, there was no difference in the mean improvement in
the knee scores (standardized mean difference, 0.03; 95% confidence interval,
-0.50 to 0.56).
Conclusions: The available evidence indicates that patellar
resurfacing reduces the risks of reoperation and anterior knee pain after
total knee arthroplasty. The observed effects are clinically important despite
their modest magnitude. Additional, carefully designed randomized trials are
required to strengthen this claim.
Level of Evidence: Therapeutic Level I. See Instructions
to Authors for a complete description of levels of evidence.