Long-Term Comparison Study of Patella Resurfacing Versus Non-resurfacing in Total Knee Arthroplasty with Minimum 10-Year Follow-Up.

Abstract

Management of the patella during total knee arthroplasty is a matter of constant debate. Numerous studies have assessed and compared the mechanical and clinical results of total knee arthroplasty with native as well as resurfaced patellae. However, the consensus has not been reached yet on this subject. This study aims to compare the outcome between patella resurfaced (PR) and non-resurfaced patellae (NPR) after a follow-up of minimum 10years following total knee arthroplasty. This is a retrospective study including 63 subjects (103 knees) who had undergone total knee arthroplasty with a follow-up of 10-14years. In this study, we evaluated the knees implanted with either press fit condylar (PFC) sigma (Depuy, Johnson & Johnson) or Nexgen (CR flex/LPS flex) (Zimmer, Warsaw, Indiana, USA) implants. Whether to perform patella resurfacing or not and choice of implants as well as implant design (posterior stabilized/cruciate retaining) was surgeons' preference. At final follow-up, clinical and functional outcome was assessed using Knee Society Scores (KSS), and comparison of difference between pre-op scores and scores at final follow-up among resurfaced versus non-resurfaced patellae groups was carried out. Patello-femoral function was assessed at final follow-up using Feller's score and the results were compared between resurfaced and non-resurfaced patellae. The mean follow-up was 140months (range 124-168months). There were 62 knees with their patella resurfaced and 41 knees with non-resurfaced patellae There was no significant difference in the mean pre-op Knee Society Scores between PR (46.29 ± 5.17) and NPR (47.34 ± 5.95), p value 0.34. Similarly there was no significant difference in their pre-op functional score as well PR (38.53 ± 5.14) and NPR (39.22 ± 6.79), p value 0.56. Both groups had significantly improved post-operative Knee Society Scores PR (85.95 ± 5.23) and NPR (84.65 ± 5.30). However, there is no difference between these groups, p value 0.22. Functional scores also maintained significant improvement at final follow-up. Between the two groups, the resurfaced group showed a significantly higher functional score at final follow-up: PR (70.90 ± 7.73) and NPR (66.44 ± 7.12), p value 0.02. Feller's score at final follow-up for PR group was (23.36) and NPR group was (21.98), p value 0.001, which showed clear superiority of PR over NPR. After a minimum follow-up of 10years, there were no differences in clinical results; however, the knee function score and patello-femoral function scoring was found to be significantly higher with patella resurfacing and it was persistent across all the subgroups we had included in the study-posterior stabilized/cruciate retaining or between implants made by two different manufacturers.