Resurfacing In Total Knee Arthroplasty Research Articles

A kinematic and kinetic analysis of walking after total knee arthroplasty with and without patellar resurfacing

Clarification of the indications for patellar resurfacing in total knee arthroplasty (TKA) is still necessary. Few studies of adequate power have evaluated functional differences between total knee arthroplasty with and without patellar resurfacing, in particular walking gait. This study aimed to identify clinically relevant differences in knee kinematic or kinetic parameters during level walking between total knee arthroplasty with and without patellar resurfacing, after controlling for pre-surgery gait parameters. Kinematic and kinetic gait analysis of level walking was performed on 34 subjects (41 knees) before and 12-18 months after total knee arthroplasty with patellar resurfacing performed randomly. Linear regression analysis was used to examine the influence of patellar resurfacing upon gait variables whilst controlling for the corresponding pre-surgery measure. The pre-surgery value was a moderate to strong significant predictor of all post-surgery temporal-spatial and kinetic gait parameters (p < 0.001-0.008), and most kinematic parameters (p < 0.001-0.066). The addition of patellar resurfacing to the regression models did not improve the predictive power in any case. Only one parameter, knee flexion at heel-strike, displayed a difference near statistical significance between total knee arthroplasty with and without patellar resurfacing (10 degrees versus 7 degrees respectively, p = 0.023). Pre-surgery gait patterns are an important determinant of post-surgery gait. There are no clinically relevant differences in walking gait between total knee arthroplasty performed with or without patellar resurfacing, using the Profix design.

Patellar Resurfacing in Total Knee Arthroplasty: A Meta-analysis

Patellar Resurfacing in Total Knee Arthroplasty: A Meta-analysis

Correlation of the condition of the patellar articular cartilage and patellofemoral symptoms and function in osteoarthritic patients undergoing total knee arthroplasty

We sought to determine the degree of correlation between the condition of the patellar articular cartilage and patellofemoral symptoms and function in osteoarthritic patients undergoing total knee arthroplasty. The depth of the osteoarthritic lesion, as graded by the Outerbridge classification and its size and location were assessed to determine the condition of the patellar cartilage in 80 consecutive osteoarthritic knees undergoing total knee arthroplasty. The association between the condition of the cartilage and patellofemoral symptoms and function was investigated by correlation analysis. The depth and size of the lesion had a significant but weak correlation with anterior knee pain (r = -0.300 and -0.289; p = 0.007 and 0.009, respectively), whereas location had no significant association (p > 0.05). None had a significant association with patellofemoral functional parameters (chair-rising, stair-climbing, and quadriceps power) (p > 0.05). Our study indicates that patellofemoral symptoms and function are not completely determined by the condition of the cartilage. Caution should be taken when the symptoms and functional limitations are attributed to a lesion in the patellofemoral joint in making a decision regarding patellar resurfacing in total knee arthroplasty.

The John Insall Award :Patella Resurfacing versus Nonresurfacing in Total Knee Arthroplasty

Patellar resurfacing in total knee arthroplasty remains controversial. This study evaluates the results of resurfacing and nonresurfacing the patella in a randomized controlled, clinical trial at a minimum of 10 years followup. One hundred knees (90 patients) with osteoarthritis were enrolled in a p

Evidence in orthopaedics: patellar resurfacing in total knee arthroplasty

Four good quality randomized clinical trials comparing patellar resurfacing versus noresurfacing in knee arthroplasty are analyzed. The outcomes evaluated were anterior knee pain, scores on the Knee Society’s rating system and reoperation. No relevant differences were found in knee scores, but anterior knee pain was less frequent in patients with patellar resurfacing. Few patients had severe anterior knee pain. Still, patients with anterior knee pain were less satisfied with the clinical result. Studies with longer follow-up showed that anterior knee pain increased with time in both groups. A clinically relevant increase in reoperation rate in the nonresurfaced group could not be excluded with the numbers available. Anterior knee pain seems to be influenced by the decision of resurfacing the patella during knee arthoplasty. Although it is not associated with important changes in knee scores, patients perceive it as a cause of insatisfaction. Influence of patellar resurfacing on implant supervivence is not clear.

Patella resurfacing in total knee arthroplasty

This is the protocol for a review and there is no abstract. The objectives are as follows: To identify and summarise the evidence from randomised controlled trials assessing the clinical efficacy and safety of resurfacing the patella versus not resurfacing the patella in total knee arthroplasty. The following null hypotheses will be tested: 1.There is no difference in outcome between resurfacing the patella and not resurfacing the patella in patients with osteoarthritis of the knee. 2.There is no difference in outcome between resurfacing the patella and not resurfacing the patella in patients with inflammatory arthritis of the knee. 3.There is no difference in outcome between not resurfacing the patella and resurfacing the patella with different prosthetic designs. 4.There is no difference in outcome between resurfacing the patella and not resurfacing the patella in patients with grade varying grades of patellofemoral arthritis, and varus or valgus deformity of the knee

Patellar Resurfacing in Total Knee Arthroplasty

To The Editor: In the article by Waters and Bentley entitled “Patellar Resurfacing in Total Knee Arthroplasty. A Prospective, Randomized Study” (2003;85:212-7), the authors do not state whether the sizing of the femoral component was anteriorly or posteriorly referenced. Both systems are available for the PFC knee. Posterior referencing for the anteroposterior dimensions of the femoral component leads to a precise sizing of the … Corresponding author: T.S. Waters, MRCS Institute of Orthopaedics The Royal National Orthopaedic Hospital Trust Brockley Hill, Stanmore, Middlesex, HA7 4LP United Kingdom mail{at}timwaters.com

Patellar Resurfacing in Total Knee Arthroplasty

Patellar Resurfacing in Total Knee Arthroplasty

Patellar Resurfacing in Total Knee Arthroplasty

Background: Anterior knee pain following total knee arthroplasty is a common complaint and typically is attributed to the patellofemoral joint. The purpose of the present study was to compare the outcome of resurfacing and nonresurfacing of the patella, particularly with regard to anterior knee pain, and to clarify the indications for patellar resurfacing at the time of total knee arthroplasty. Methods: We performed a prospective, randomized study of 514 consecutive primary press-fit condylar total knee replacements. The patients were randomized to either resurfacing or retention of the patella. They were also randomized to either a cruciate-substituting or a cruciate-retaining prosthesis as part of a separate trial. The mean duration of follow-up was 5.3 years (range, two to 8.5 years), and the patients were assessed with use of the Knee Society rating, a clinical anterior knee pain score, and the British Orthopaedic Association patient-satisfaction score. The assessment was performed without the examiner knowing whether the patella had been resurfaced. At the time of follow-up, there were 474 knees. Thirty-five patients who had a bilateral knee replacement underwent resurfacing on one side only. Results: The overall prevalence of anterior knee pain was 25.1% (fifty-eight of 231 knees) in the nonresurfacing group, compared with 5.3% (thirteen of 243 knees) in the resurfacing group (p < 0.0001). There was one case of component loosening. Ten of eleven patients who underwent secondary resurfacing had complete relief of anterior knee pain. The overall postoperative knee scores were lower in the nonresurfacing group, and the difference was significant among patients with osteoarthritis (p < 0.01). There was no significant difference between the resurfacing and nonresurfacing groups with regard to the postoperative function score. Patients who had a bilateral knee replacement were more likely to prefer the resurfaced side. Conclusions: As the present study showed a significantly higher rate of anterior knee pain following arthroplasty without patellar resurfacing, we recommend patellar resurfacing at the time of total knee replacement when technically possible. Level of Evidence: Therapeutic study, Level I-1a (Randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

Secondary patellar resurfacing in total knee arthroplasty: results of multivariate analysis in two case-matched groups

Although patellofemoral symptoms after patellar-retaining knee arthroplasty are common, no evidence has been published in the literature on the potential benefit from patellar resurfacing at a later stage. This study evaluates the effect of secondary (delayed) patellar resurfacing using comparisons between 2 case-matched groups of patients with primary and secondary patellar resurfacing. Furthermore, multivariate statistical methods were applied to study factors that may influence the final outcome. Our results suggest that although significant clinical improvement was seen after delayed patella resurfacing, the outcome of secondary patellar resurfacing is inferior to that expected for a similar group of patients with primary resurfacing. Furthermore, the timing (delay period) of the secondary resurfacing procedure appears to negatively affect the final outcome. This suggests that secondary patellar resurfacing, when indicated, should be considered at an early stage.

The Role of Patellar Resurfacing in Total Knee Arthroplasty

The ideal treatment of the patella in primary total knee arthroplasty (TKA) for osteoarthritis (OA) remains unclear. Although data exist in the literature to support either resurfacing or not resurfacing the patella, evidence continues to emerge that unresurfaced patellas deteriorate with time. Recent prospective, randomized studies also favor patellar resurfacing over retaining the native patella, reporting reoperation rates to convert unresurfaced to resurfaced patellas exceeding those for complications after patellar resurfacing. In addition, the incidence of residual patellofemoral pain after secondary resurfacing is substantially higher than when patellofemoral resurfacing is done primarily. Patient selection criteria are critical in the decision-making process. Patellofemoral complications, the greatest argument against resurfacing, have been diminished with improved surgical techniques and implant design.

The role of patellar resurfacing in total knee arthroplasty.

The ideal treatment of the patella in primary total knee arthroplasty (TKA) for osteoarthritis (OA) remains unclear. Although data exist in the literature to support either resurfacing or not resurfacing the patella, evidence continues to emerge that unresurfaced patellas deteriorate with time. Recent prospective, randomized studies also favor patellar resurfacing over retaining the native patella, reporting reoperation rates to convert unresurfaced to resurfaced patellas exceeding those for complications after patellar resurfacing. In addition, the incidence of residual patellofemoral pain after secondary resurfacing is substantially higher than when patellofemoral resurfacing is done primarily. Patient selection criteria are critical in the decision-making process. Patellofemoral complications, the greatest argument against resurfacing, have been diminished with improved surgical techniques and implant design.

Resurfacing versus not resurfacing the patella in total knee arthroplasty: 8- to 10-year results

Patellar resurfacing in total knee arthroplasty is a topic debated in the literature. Concerns include fracture, dislocation, loosening, and extensor mechanism injury. Residual anterior knee pain has been reported when the patella is not resurfaced. One hundred patients with osteoarthritic knees were prospectively randomized to either have their patella resurfaced or left not resurfaced. All patients were treated with a single prosthesis that featured an anatomically designed patellofemoral articulation (Anatomic Medullary Knee, DePuy, Warsaw, IN) Two patients in the unresurfaced group and one in the resurfaced group required repeat surgery for patellofemoral complications. At 8- to 10-year follow-up evaluations, Knee Society Clinical Ratings scores were not different between the 2 groups. Rates of anterior knee pain with walking and stair climbing were significantly less in the resurfaced group. Eighty percent of patients with a resurfaced patella were extremely satisfied with their total knee arthroplasty versus 48% without patellar resurfacing. When satisfied and extremely satisfied patients were grouped together, there was no difference between the 2 groups.

The patella in revision total knee arthroplasty.

The prevalence of patellofemoral complications following resurfacing in total knee arthroplasty has been reported to range from 4% to 41%1,2. Complications related to the patellofemoral articulation are the cause of up to 45% of all total knee arthroplasty revisions3 and 41% of re-revisions. Boyd et al.1 showed an increased reoperation rate in patients in whom the patella was not resurfaced. This article will discuss the diagnosis and treatment of problems that occur at the patellofemoral articulation as well as issues related to the management of the patellofemoral joint and extensor mechanism during revision total knee arthroplasty, including evaluation of component fixation, assessment of compatibility of preexisting well-fixed components with revision implants, and management of patellar bone loss. The extensor mechanism is composed of the quadriceps muscle and tendon, the patella, the patellar tendon, and their insertions into the tibial tuberosity. The patella functions in this mechanism as a pulley, altering the direction of quadriceps force and increasing the lever arm of the quadriceps in its role of extending the knee, thus resulting in a decrease in (tibiofemoral) reactive forces. The patella and the extensor mechanism also function as secondary restraints to anteroposterior translation of the tibiofemoral joint. The trochlea of the femur serves as a constraining articulation that maintains the position of the patella anterior to the femur. Maintenance of this position allows for maximum mechanical advantage of the entire muscle-tendon-bone unit. Failure of this construct at any point along its length leads to either complete inability to extend the knee joint or to substantial weakness. During the past two decades, there have been improvements in the design of patellar and femoral components and a better understanding of the surgical techniques needed to ensure proper function of the patellofemoral articulation and the extensor mechanism. …

Functional and Radiological Outcomes of Patella Retaining Total Knee Arthroplasty: Minimun 5-Year Follow-up Results

Purpose : Conflicting results have been reported for patellar resurfacing in total knee arthroplasty. We reviewed the clinical and radiological results of patella retaining total knee arthroplasties retrospectively. Materials and Methods : Patella retaining total knee arthroplasty using a press-fit condylar (PFC) model by the hybrid technique was reviewed retrospectively in 27 knees (22 patients). Clinical evaluation was done according to HSS knee and patella scores. Radiographic assessment was made by measuring the patellofemoral joint space (mild, moderate, and severe loss), patellar sclerosis, patellar tilt, and patellar subluxation. Results : The mean HSS knee score improved from 58 to 87 and the patellar score was found to be good or excellent in 85% (23/27) of cases. Patellar sclerosis was found in 10 cases (9 lateral and 1 medial) and patellar tilting was found in 4 cases (15%). Correlation between the radiographic findings and the clinical scores was statistically indifferent (p>0.05). Conclusion : Patella retaining total knee arthroplasty may reduce patellofemoral complications but long term radiographic and clinical follow-up including patellar sclerosis, patellar tilting, and patellar subluxation is recommended.

Patellar Resurfacing in Total Knee Arthroplasty

Whether to resurface the patella during a primary total knee arthroplasty performed for the treatment of degenerative osteoarthritis remains a controversial issue. Parameters that have been suggested as being useful in guiding this decision include patient height and weight, the presence of anterior knee pain preoperatively, and the grade of chondromalacia encountered intraoperatively. The purpose of this study was to determine whether these parameters were predictive of the clinical result following total knee arthroplasty with or without patellar resurfacing. Eighty-six patients (118 knees) undergoing primary total knee arthroplasty for the treatment of osteoarthritis were enrolled in a prospective, randomized, double-blind study. All patients received the same posterior-cruciate-sparing total knee prosthetic components. Patients were randomized to treatment with or without resurfacing of the patella. Evaluations consisted of the determination of a Knee Society clinical score, the completion of a patient satisfaction questionnaire, specific questions relating to patellofemoral symptoms, and radiographs. Sixty-seven patients (ninety-three knees) were followed for a minimum of five years (range, sixty to eighty-four months; average, 70.5 months). With the numbers available, there was no significant difference between the groups treated with and without resurfacing with regard to the overall Knee Society score or the pain and function subscores. Obesity, the degree of patellar chondromalacia, and the presence of preoperative anterior knee pain did not predict postoperative clinical scores or the presence of postoperative anterior knee pain. The occurrence of anterior knee pain could not be predicted with any clinical or radiographic parameter studied. On the basis of these results, it seems likely that postoperative anterior knee pain is related either to the component design or to the details of the surgical technique, such as component rotation, rather than to whether or not the patella is resurfaced.

Patellar resurfacing in total knee arthroplasty.

Whether or not to resurface the patella when performing a primary total knee arthroplasty remains an open question. A number of recent studies have added new information relevant to this controversy. Anatomic studies show that there is normally substantial variability in the anatomy of the trochlear groove. Implanting a femoral component therefore results in a change in the surface topography of the knee in a high percentage of cases. Even though a number of intraoperative techniques have been described in an attempt to accurately reproduce femoral and tibial component rotation, studies of the application of these techniques reveal that component malpositioning or malrotation of a measurable degree occurs in 10% to 30% of cases, depending on the surgical technique and landmarks used. There has been substantial change in the design of both femoral and patellar components in recent years. Even with current designs, biomechanical studies indicate that some degree of change in kinematics and contact stresses occurs following total knee arthroplasty. However, the results of clinical studies have been extremely variable, with most showing either no difference or very little difference between resurfaced and nonresurfaced patellae in osteoarthritic knees. The decision to resurface the patella or not must be individualized on the basis of the surgeon's training and experience and an intraoperative assessment of the patellofemoral articulation.

Patellar contact forces with and without patellar resurfacing in total knee arthroplasty

Patellar contact forces were measured in 7 fresh frozen cadaver knees during continuous flexion-extension cycling for the normal knee and after total knee arthroplasty without and with patellar resurfacing using 2 prosthesis systems with different designs for the femoral and patellar components. Analysis of variance with specimen as a repeated measure was used to examine the effect of contact surface. When compared to normal knees, total knee arthroplasty without patellar resurfacing resulted in no change in patellar contact forces. The magnitude of the inferosuperior patellar shear force increased significantly after patellar replacementwith an oval, biconcave patellar component and increased further after replacement with an oval, domed patellar component. There were no significant changes in the mediolateral and anteroposterior contact force components after patellar replacement

Patellar resurfacing in total knee arthroplasty, current state of the controversy

This article reviews the current controversy of resurfacing the patella in total knee arthroplasty. Up-to-date knowledge of experimental and biomechanical studies as well as the different types of implants and specifics of the patella preparation are described in detail. The author furthermore discusses the relevant clinical studies dealing with patellar resurfacing and tries to guide the reader in evaluating the results. Finally is summarized why the indication for resurfacing the patella is so controversial and how a differentiated indication for resurfacing the patella could be specified.

Patellar resurfacing in total knee arthroplasty

Patellar resurfacing in total knee arthroplasty