Functional outcome of patellar resurfacing vs non resurfacing in Total Knee Arthoplasty in elderly: A prospective five year follow-up study

Abstract

IntroductionOsteoarthritis of knee is one of the most common orthopaedic problems of elderly. Total knee arthroplasty is a common surgical procedure. Many of the poor functional outcomes are related to problems of patellofemoral joint and there is considerable debate whether patella should be resurfaced or not at the time of total knee arthroplasty. Material & methodsA total of 100 subjects were evaluated and were further randomized equally into two arms by using standard computer generated random table. Each arm was designated to either RS or Non RS between June 2011 to May 2013 at Department of Orthopaedic Surgery, Goa Medical College and Hospital followed by approval of ethical committee. Exclusion criteria for the study included history of patella fracture, age <50 years, Patellofemoral instability, Prior patellectomy, Prior knee replacement surgery, Prior hip replacement surgery, Patient with osteoarthritis of hip, Prior history of tibial condyle or distal femoral fractures. Chi square test was used for statistic analysis. ResultsKnee society score including clinical and functional (KSS) were performed for assessment. There were a total of 80 female and 20 male patients. Out of 80 female knees, 41 were resurfaced and 39 were not. Out of 20 male knees, 9 were resurfaced and 11 were not. Mean clinical knee score ranging from 0 to 100 points in the resurfaced group improved from 28.6 to 84.14 and; from 24.72 to 86.2 in the non resurfaced group. The difference in the clinical knee score amongst resurfaced and non resurfaced group was not statistically significant at 5 years follow up. The mean functional knee score on a range of 0–100 point went up from 39.1 to 90.1 in resurfaced group and; from 45 to 92.4 in the non resurfaced group. The difference in functional knee score amongst resurfaced and non resurfaced groups is not statistically significant even at 5 years follow up post operatively. However NRS group received better increment in scores than RS group. Visual Analogue Scale (VAS) was used for anterior knee pain assessment pre and post operatively in both groups and was not statistically significant as well. None of the patients underwent revision of total knee replacement after the primary procedure. ConclusionA similar knee evaluation score was observed in both RS and NRS groups after 5 year of follow up. However, it appears that non-resurfacing had shown marginally better scores than resurfacing group.