Patellar resurfacing after endoprosthetic replacement for primary or secondary bone tumors.

Abstract

The question of whether or not to resurface the patella during primary total knee replacement (TKR) is an enduring controversy in orthopaedic surgery (1-4). Opinion is divided—some surgeons will routinely resurface the patella, some will never resurface and the remainder will resurface or not on the basis of the appearance of the patella at operation or the location of the patient’s pain. Osteoarthritis (OA), the most common indication for TKR, is considered to be a disease of the whole joint and proponents of resurfacing suggest that the whole joint should be treated; indeed, a proportion of cases in whom patellar resurfacing is not performed will later go on to undergo secondary resurfacing. Those who do not tend to resurface the patella point to the morbidity associated with patellar resurfacing, which may predispose to patellar fracture and extensor mechanism rupture (5). On the basis of the current evidence, patellar resurfacing appears to have a small effect the overall rate of revision following surgery (probably as a result of eliminating secondary resurfacing), but has little or no effect on patient-reported outcome measures (PROMs) after TKR (2).