To Resurface the Patella or Not? Better Assessments Needed to Address the Benefits for Total Knee Replacement

Abstract

Low-friction metal-on-polyethylene primary total knee arthroplasty has been utilized for forty years, and anterior knee pain has been an issue for all of that time. The first implants either ignored the patellofemoral joint or even compromised it by means of a transverse metal bar that joined the medial and lateral condylar femoral components. Anterior knee pain was common, developing in 40% to 58% of patients1. As a result, attempts were made to address the patellofemoral joint in the design of future total knee arthroplasties. The first initiative was to add an anterior flange to the femoral component, and this was followed shortly by the addition of a polyethylene resurfacing button to the articular surface of the patella that articulated with the anterior flange of the femoral component2. The prevalence of anterior knee pain was greatly reduced by these changes, but it was not completely eliminated. Since that time, continued patellofemoral-related changes have been made, such as a move to specific right and left femoral components, closer replication of normal patellar tracking, and deepening of the patellar groove in the femoral component3. Despite these improvements, consensus was not reached with regard to how to deal with the patellofemoral joint during total knee arthroplasty. Complications …