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Scientific Articles   |    
Patellar Resurfacing in Total Knee Arthroplasty: Does Design Matter?A Meta-Analysis of 7075 Cases
George Pavlou, BSc, MRCS1; Carl Meyer, MScOrth, FRCS1; Andreas Leonidou, MRCS2; Mohammed As-Sultany, BSc, MRCS3; Robert West, DPhil, FIMA4; Eleftherios Tsiridis, MD, MSc, PhD, FRCS2
1 Robert Jones Agnes Hunt Orthopaedic Hospital, Gabowen, Oswestry SY10-7AG, United Kingdom
2 Academic Department of Orthopaedics, Division of Surgery, Aristotle University Medical School, Unversity Campus GR 54124, Thessaloniki, Greece. E-mail address for E. Tsiridis: etsiridis@doctors.org.uk
3 Royal United Hospital, Combe Park, Bath BA1 3NG, United Kingdom
4 Institute of Health Sciences, Centre for Epidemiology and Biostatistics, Charles Thackrah Building, 101 Clarendon Road, Leeds University, Leeds LS2 9L, United Kingdom
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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. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, 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 the authors of this work are available with the online version of this article at jbjs.org.

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Investigation performed at the Academic Department of Orthopaedics, Division of Surgery, Aristotle University Medical School, Thessaloniki, Greece
A commentary by Robert B. Bourne, MD, FRCSC, is linked to the online version of this article at jbjs.org.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Jul 20;93(14):1301-1309. doi: 10.2106/JBJS.J.00594
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Abstract

Background: 

Patellar resurfacing in total knee arthroplasty remains controversial. The aim of this study was to compare outcomes following total knee arthroplasty with patellar resurfacing with those following total knee arthroplasty without patellar resurfacing. We also sought to identify any correlation between outcomes and prosthetic design.

Methods: 

Eighteen Level-I randomized controlled trials with a cumulative sample size of 7075 knees (3463 in the resurfacing group and 3612 in the non-resurfacing group) satisfied the inclusion criteria. In the primary analysis, patellar resurfacing total knee arthroplasty was compared with non-resurfacing total knee arthroplasty, with use of reoperation rates, incidence of anterior knee pain, and functional scores as outcome measures. The secondary analysis focused on comparing patella-friendly and non-patella-friendly total knee arthroplasty designs with regard to the same three outcome measures.

Results: 

No significant differences were found between the resurfacing and non-resurfacing groups with regard to the incidence of anterior knee pain. A higher rate of reoperations was observed in the non-resurfacing group. Analysis of homogeneous data comparing patella-friendly with non-patella-friendly total knee arthroplasty designs demonstrated no differences in the incidence of reoperations.

Conclusions: 

No evidence was found to suggest that either patellar resurfacing or the prosthetic design affects the clinical outcome of a total knee arthroplasty. The higher incidence of reoperations in the non-resurfacing group may be attributed to the fact that secondary patellar resurfacing adds a surgical option for the treatment of anterior knee pain following total knee arthroplasty, thus artificially increasing the rate of reoperations in the non-resurfacing group.

Level of Evidence: 

Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

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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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