Secondary Patellar Resurfacing Research Articles

Lateral Patellar Facetectomy and Medial Reefing in Patients With Lateral Facet Syndrome After Patellar-Retaining Total Knee Arthroplasty

We analyzed clinical outcomes of partial lateral patellar facetectomy and medial reefing in patients with lateral patellar facet syndrome with painful patellar-retaining total knee arthroplasty. 34 patients were followed for a mean of 40 months. All 34 patients were matched with those having secondary patellar resurfacing without facetectomy. Both groups experienced significant pain relief and range of motion improvement. The facetectomy group had higher Kujala scores than those in patellar resurfacing group. Patients with facetectomy had significantly less pain postoperatively. There were significant differences in postoperative lateral patellar tilt and congruency angle in both groups. The mid-term results for LPF with medial reefing are promising to resolve pain in patients with lateral patellar facet syndrome in patellar-retaining TKA. Therapeutic level III (retrospective comparative study).

A randomised, controlled trial of circumpatellar electrocautery in total knee replacement without patellar resurfacing

In the absence of patellar resurfacing, we have previously shown that the use of electrocautery around the margin of the patella improved the one-year clinical outcome of total knee replacement (TKR). In this prospective randomised study we compared the mean 3.7 year (1.1 to 4.2) clinical outcomes of 300 TKRs performed with and without electrocautery of the patellar rim: this is an update of a previous report. The overall prevalence of anterior knee pain was 32% (95% confidence intervals [CI] 26 to 39), and 26% (95% CI 18 to 35) in the intervention group compared with 38% (95% CI 29 to 48) in the control group (chi-squared test; p = 0.06). The overall prevalence of anterior knee pain remained unchanged between the one-year and 3.7 year follow-up (chi-squared test; p = 0.12). The mean total Western Ontario McMasters Universities Osteoarthritis Indices and the American Knee Society knee and function scores at 3.7 years' follow-up were similar in the intervention and control groups (repeated measures analysis of variance p = 0.43, p = 0.09 and p = 0.59, respectively). There were no complications. A total of ten patients (intervention group three, control group seven) required secondary patellar resurfacing after the first year. Our study suggests that the improved clinical outcome with electrocautery denervation compared with no electrocautery is not maintained at a mean of 3.7 years' follow-up.

Does malrotation of components correlate with patient dissatisfaction following secondary patellar resurfacing?

BackgroundThe aim of our study was to identify whether there was any correlation between the outcome of secondary patellar resurfacing and malrotation of either the femoral or tibial component. MethodsWe identified patients that underwent secondary patellar resurfacing following previous primary total knee arthroplasty (TKA) at a single, large orthopaedic department. Patients were reviewed for range of movement, satisfaction, health status and knee function. CT scanning was performed, assessing rotational alignment of the components. ResultsTwenty-one patients (23 knees) were reviewed. Nine out of 21 (39%) were satisfied while 14 (61%) remained dissatisfied after the secondary patellar resurfacing. There were no complications after the secondary procedure. All knees were internally rotated. The mean femoral internal rotation in the satisfied group was 0.92°, and in the dissatisfied group was 2.88° of internal rotation. In the dissatisfied group eight out of 14 TKAs were in >3° femoral internal rotation compared with only one in nine TKAs in the satisfied group (p<0.05). ConclusionsInvestigation for malrotation should be considered in patients with post-operative pain, especially anteriorly, causing significant dissatisfaction amongst patients following TKA. This is especially true if the patella has not been primarily resurfaced and secondary resurfacing is being considered. Patients with more than 3° of femoral internal rotation undergoing secondary patella resurfacing should be warned of the possibility of a poor outcome. It may well be that if the underlying problem is component malrotation, revision knee replacement may lead to a more satisfactory outcome than secondary resurfacing alone. Level of EvidenceLevel of Evidence III.

Secondary Patellar Resurfacing after Primary Bicondylar Knee Arthroplasty did Not Meet Patients’ Expectations

Secondary patella resurfacing is a controversial procedure which is applied in patients with anterior knee pain after a bicondylar knee arthroplasty (with unresurfaced patella). A group of 46 patients were submitted to this procedure and their satisfaction, range of motion and pain improvement was evaluated. 52.2% of the patients were satisfied with the procedure, with an improvement in pain (Visual Analogue Scale) of 65% and an improvement in range of motion in 56,5%, with roundabout half of the patients having no resolution to their complaints. Whilst an improvement was not achieved in all patients, as it was initially hypothesised, this procedure should be considered when a revision knee arthroplasty is performed with an unresurfaced patella.

Outcome of secondary patellar resurfacing

Outcome of secondary patellar resurfacing

Revision Surgery for Patellofemoral Problems: Should We Always Resurface?

Routine patellar resurfacing performed at the time of knee arthroplasty is controversial, with some evidence of utility in both TKA (tricompartmental) and bicompartmental knee arthroplasty. However, whether one approach results in better implant survival remains unclear. We asked whether (1) routine patellar resurfacing in TKAs resulted in lower cumulative revision rates compared to bicompartmental knee arthroplasties, (2) patella-friendly implants resulted in lower cumulative revision rates than earlier designs, and (3) bicompartmental knee arthroplasties revised to TKAs had higher cumulative revision rates than primary TKAs. From a community-based joint registry, we identified 8135 patients treated with 9530 cemented, all-polyethylene patella TKAs and 627 bicompartmental knee arthroplasties without patellar resurfacing. We compared age, gender, year of index procedure, diagnosis, cruciate status, revision, and revision reason. TKAs had a lower cumulative revision rate for patella-only revision than bicompartmental knee arthroplasties (0.8% versus 4.8%). Adjusting for age, bicompartmental knee arthroplasties were 6.9 times more likely to undergo patellar revision than TKAs. There was no difference in the cumulative revision rate for patella-only revisions between patella-friendly and earlier designs. The cumulative revision rate for any second revision after a patella-only revision was 12.7% for bicompartmental knee arthroplasties while that for primary TKAs was 6.3%. Bicompartmental knee arthroplasties had higher revision rates than TKAs. Femoral component design did not influence the cumulative revision rate. Secondary patella resurfacing in a bicompartmental knee arthroplasty carried an increased revision risk compared to resurfacing at the time of index TKA. To reduce the probability of reoperation for patellofemoral problems, our data suggest the patella should be resurfaced at the time of index surgery.

Patellar Resurfacing in Total Knee Arthroplasty: Does Design Matter?

Patellar resurfacing in total knee arthroplasty remains controversial. The aim of this study was to compare outcomes following total knee arthroplasty with patellar resurfacing with those following total knee arthroplasty without patellar resurfacing. We also sought to identify any correlation between outcomes and prosthetic design. Eighteen Level-I randomized controlled trials with a cumulative sample size of 7075 knees (3463 in the resurfacing group and 3612 in the non-resurfacing group) satisfied the inclusion criteria. In the primary analysis, patellar resurfacing total knee arthroplasty was compared with non-resurfacing total knee arthroplasty, with use of reoperation rates, incidence of anterior knee pain, and functional scores as outcome measures. The secondary analysis focused on comparing patella-friendly and non-patella-friendly total knee arthroplasty designs with regard to the same three outcome measures. No significant differences were found between the resurfacing and non-resurfacing groups with regard to the incidence of anterior knee pain. A higher rate of reoperations was observed in the non-resurfacing group. Analysis of homogeneous data comparing patella-friendly with non-patella-friendly total knee arthroplasty designs demonstrated no differences in the incidence of reoperations. No evidence was found to suggest that either patellar resurfacing or the prosthetic design affects the clinical outcome of a total knee arthroplasty. The higher incidence of reoperations in the non-resurfacing group may be attributed to the fact that secondary patellar resurfacing adds a surgical option for the treatment of anterior knee pain following total knee arthroplasty, thus artificially increasing the rate of reoperations in the non-resurfacing group.

Secondary Resurfacing of the Patella After Primary Total Knee Arthroplasty: Does the Anterior Knee Pain Resolve?

Although it has been shown that the risk of anterior knee pain is greater in patients with nonresurfaced patellae, it is not exactly clear whether the pain would resolve with secondary resurfacing of the patella. Thirty-nine patients (41 knees) underwent secondary patellar resurfacing between January 2001 and January 2007. The mean age was 66 years. The mean body mass index was 29.2 kg/m 2. The average time from primary total knee arthroplasty to resurfacing procedure was 29 months. The mean follow-up was 54 months. Anterior knee pain was the indication for secondary resurfacing in all patients. Although the clinical and functional knee scores improved significantly for whole cohort, 8 patients (8 knees) were dissatisfied with the outcome of surgery. This study highlights that secondary resurfacing is not an always rewarding procedure and patients need to be consulted appropriately with regard to the outcome.

Secondary patellar resurfacing in the treatment of patellofemoral pain after total knee arthroplasty

This paper reports a prospective review of patients who, between 2004 and 2007, underwent secondary patellar resurfacing (SPR) due to anterior knee pain after a primary total knee arthroplasty (TKA). The aim was to evaluate the clinical outcomes obtained with the SPR and to compare them with radiological findings. A total of twenty-seven consecutive patients met the inclusion criteria. There were twenty-three (85%) women and four (15%) men with a median age of 70 years. The patients were evaluated before and after the surgery with the same functional scores and radiological parameters. Bone scintigraphy was also used in the assessment, and a CT-scan was performed in order to evaluate the femoral component rotation. The median time between TKA and SPR was 18 months. With a median follow-up of 23 months, seventeen patients (63%) reported a clear subjective improvement after SPR, and patellofemoral scores (primary outcome measure), KSS and WOMAC (secondary outcome measures) showed a statistically significant improvement following the procedure. There were no significant changes after SPR in the Insall-Salvati ratio, the lateral patellar displacement or the lateral patellar tilt. The mean time between TKA and SPR had no statistically significant effect on outcome. The bone scintigraphy revealed increased patellar uptake in seven cases, but this was not related to subsequent improvement after SPR. Rotational computed tomography showed a median internal rotation of the femoral component of 1º. The complications observed were a patellar component loosening and an acute post-infection. No clinical or radiological parameter was found to be related to the final outcome after SPR. There was a discrepancy between functional scale scores and the patient's subjective satisfaction.

Secondary Resurfacing of the Patella after Primary TKA: Does the Anterior Knee Pain Resolve?

s e37 Paper #34 Secondary Resurfacing of the Patella after Primary TKA: Does the Anterior Knee Pain Resolve? Richard H. Rothman, MD, PhD, Javad Parvizi, MD, FRCS, S.M. Javad Mortazavi, MD, Chaitu Devulapalli, BS, Peter F. Sharkey, MD, William J. Hozack, MD Introduction: The issue of patellar resurfacing during TKA still continues to be debated. Although it has been shown that the risk of anterior knee pain (AKP) is greater in patients with non-resurfaced patellae, it is not exactly clear whether the pain would resolve with secondary resurfacing of the patella. The purpose of this study was to determine the outcome of secondary patellar resurfacing after primary TKA. Material and Methods: The computerized database was used to identify all patients undergoing secondary resurfacing or patella after TKA at our institution. Forty-one secondary patellar resurfacing were carried out on 39 patients between August 2000 and January 2007. The mean age of patients was 68 years (range, 43-84). The mean BMI of patients was 29.2 (22.6-52.7). The average time from primary TKA to resurfacing procedure was 28.8 months (range, 4.4-79.1). The mean follow-up was 48.1 months (range, 12-89.7). Result: Anterior knee pain was the indication for secondary resurfacing. The mean clinical knee society score (KSS) improved from 66 to 83 points and the mean functional KSS from 48.2 to 60.3 (P = .0002). The knee pain also significantly improved from a mean of 19.7 to 36.7 postoperatively (P = .0001). Nine patients (22%) were dissatisfied with the outcome of surgery; 6 of them needed further reoperations. Conclusion: Our data showed that the overall pain significantly decreased after secondary patellar resurfacing, yet a considerable number of patients were unsatisfied with the result of second surgery. This highlights the fact that anterior knee pain after TKA could have multiple etiologies and non-resurfaced patella is not the sole cause of this problem. Given our modest success with secondary resurfacing, patients undergoing this procedure should be counseled appropriately.

The need for patellar resurfacing in total knee arthroplasty: a literature review

The controversy over whether or not to routinely resurface the patella during a total knee arthroplasty has persisted despite three decades of successful joint replacement procedures. Advocates for routine patellar resurfacing admit the occasional need for secondary patellar resurfacing and declare increased incidence of anterior knee pain in patients with non-resurfaced patellae as a cause for worry. Surgeons that leave the patella unresurfaced cite avoidance of complications that include patellar fracture, avascular necrosis, patellar tendon injury and instability. This review discusses the available literature on patellar resurfacing through an evidence-based analysis of randomized and pseudo-randomized controlled trials and published meta-analyses to date. The published literature seems to favour resurfacing the patellar routinely. Selective patellar resurfacing would be the ideal solution if sound pre-operative criteria could be established. So far, a method for accurately predicting which patients can avoid patellar resurfacing has not been found. Future research looking at patellar resurfacing should concentrate on developing criteria for selecting those patients that would benefit from patellar resurfacing and those that would do as well without resurfacing, and thus, limiting potential surgical complications.

Knee joint arthroplasty after tibial osteotomy

A total of 29 consecutive knee joint arthroplasties in 24 patients who underwent previous high tibial osteotomy (HTO) for medial unicompartment osteoarthritis of the knee and followed up for a mean of 97 months were compared with a control group of 28 patients with 29 primary total knee arthroplasty (TKA) without previous HTO. Results for the osteotomy group were satisfactory in 96.5% of cases. In one patient loosening of the implant occurred after 37 months, which required prosthesis revision. Three patients underwent a further operation of secondary patella resurfacing for patella pain. The group without osteotomy reported a similar percentage of satisfactory results.

Mid-term results with a highly congruous mobile-bearing knee prosthesis

Two hundred and six consecutive total knee arthroplasties were performed in 180 patients with a highly congruous mobile-bearing knee prosthesis. At mean follow-up of 78 months (range: 60-102 months), the outcomes of 181 knees in 158 patients were evaluated using the American Knee Society's Knee and Functional scoring system and Radiological scoring system. Mean values for Knee and Function scores were 92.6 and 81.1, respectively versus 51.8 and 43.4 preoperatively; mean flexion range was 113.6 degrees versus 110.8 degrees preoperatively. There were no cases of bearing dislocation and no radiological signs of loosening or osteolysis. Secondary patella resurfacing was done in 7 of 52 knees in which the patella was not primarily resurfaced. Arthroplasty survival with revision for aseptic loosening as the endpoint was 100% (95% CI: 97.7-100) at 5 years and at 8 years (95% CI: 87.2-100); with revision of the arthroplasty for any reason including one revision for infection as the endpoint, survival was 99.5% (95% CI: 96.9-100) at 5 years and at 8 years (95% CI: 86.9-100). The overall results were satisfactory and compared with those of other mobile-bearing knee prostheses featuring full or partial congruence. No significant differences were noted for range of motion, knee scores and function scores between two subsets of knees that received a bearing allowing only rotation or rotation and 5 mm anteroposterior translation. Longer follow-up is needed to evaluate possible benefits of high congruence and of specific modes of bearing mobility with respect to wear and bony fixation.

Significance of a “hot patella” in total knee replacement without primary patellar resurfacing

A “hot patella” is a bone scan finding of increased tracer uptake in the patella, greater than the ipsilateral distal femur or the proximal tibia. Increased patellar uptake on the bone scans is a relatively frequent finding; this is often not commented upon. The aim of our study was to define the incidence of a “hot patella” on bone scans following total knee replacements with ongoing symptoms unrelated to sepsis. We wanted to investigate the correlation between the adverse retropatellar symptomatology following total knee replacement with bone scan findings.We undertook a retrospective study of 55 symptomatic total knee replacement patients, who had bone scans. The incidence of a “hot patella” in patients without primary patellar resurfacing was 51% (28/55). Ninety-five percent patients with anterior knee pain and 21% patients with diffuse knee pain had a “hot patella”. Statistical analysis showed a positive association between “hot patella” and anterior knee pain (p value of <0.001). The patients with “hot patella” who underwent secondary patellar resurfacing had symptomatic relief of symptoms.Our study has shown that the finding of a “hot patella” on a bone scan in patients with anterior knee pain following total knee replacement suggests a problem related to the patellofemoral joint. This study would appear to indicate that a “hot patella” in a patient with clinically defined anterior knee pain is likely to benefit from secondary patellar resurfacing.

Secondary patellar resurfacing in painful total knee arthroplasty

To analyze the results of the secondary patellar resurfacing (SPR) procedures carried out in our department for the treatment of patients with painful total knee arthroplasty (TKA). We retrospectively reviewed 20 patients who had undergone SPR due to persistent anterior knee pain following TKA. The mean time interval to secondary resurfacing was 24.8 months (8.5-67) and the mean follow- up was 13.5 months (2-44). Patients were evaluated radiologically and clinically through an analysis of variations in ROM and pain relief. Pain relief was reported for 60% of patients, 30% permanently and 30% temporaly with a pain-free time interval of 8.2 months (1.5-18). The radiological parameters for patellofemoral congruency improved in all patients and there was a shortening of the mean length of the patellar tendon. The mean patellar thickness increased after the secondary procedure. There were complications in 10% of patients. The reproducibility of the technique with new implants, the low rate of complications and the percentage of satisfactory results make this technique suitable for selected cases. The diverse origin of painful TKA and the complexities of diagnosis should make the surgeon weigh the situation carefully before embarking on an SPR. Analizar los resultados de las artroplastias patelares secundarias (APS) realizadas en nuestro centro sobre pacientes con artroplastia total de rodilla (ATR) dolorosa. Se estudiaron retrospectivamente 20 pacientes sobre los que se había realizado una APS por presentar una ATR con dolor de origen patelar. El intervalo medio de tiempo desde la ATR fue de 24,8 meses (8,5-67) y el seguimiento posoperatorio medio de los casos fue de 13,5 meses (2-44). Se realizó un análisis radiológico y una evaluación clínica mediante las variaciones del rango articular y el alivio del dolor. El 60% de los pacientes tuvo un alivio del dolor, el 30% de forma permanente y el 30% de forma temporal con un tiempo medio libre de dolor de 8,2 meses (1,5-18). Los parámetros radiológicos de alineación rotuliana mejoraron en todos los casos y se observó un acortamiento del tendón rotuliano. El grosor patelar medio posoperatorio fue mayor que el preoperatorio. Se observaron complicaciones en el 10% de los pacientes. La reproducibilidad de la técnica con los nuevos implantes, la baja tasa de complicaciones y las aceptables cifras de resultados satisfactorios la convierten en una técnica valorable para determinados casos. El carácter multifactorial de la ATR dolorosa con rótula nativa y la complejidad diagnóstica que esto implica debe plantear cautela a la hora de indicar una APS de forma rutinaria.

Total Knee Arthroplasty without Patellar Resurfacing in Patients with Rheumatoid Arthritis

The etiology of anterior knee pain after total knee- arthroplasty often is unclear. We prospectively followed 80 patients (139 knees) with rheumatoid arthritis who had total knee arthroplasties without patellar resurfacing from January 1998 to June 2000. We used binary logistic regression to evaluate the predictive value of preoperative anterior knee pain and the state of patellar articular cartilage on postoperative anterior knee pain. We compared the preoperative and postoperative knee and function scores for patients with and without anterior knee pain. The mean followup was 5.8 years (range, 5-7 years). Ninety one percent of the knees (127 of 139 knees) had The Knee Society scores greater than 80. Anterior knee pain developed in 12 of 139 knees (8.5%). Patients who had anterior knee pain had lower knee and function scores compared with patients without anterior knee pain. Two patients had secondary patellar resurfacing. Preoperative anterior knee pain and the state of patellar articular cartilage did not predict postoperative anterior knee pain. Kaplan-Meier survivorship analysis with anterior knee pain as the end point revealed an 88.3% survivorship at 6.5 years postoperatively. Total knee arthroplasty without patellar resurfacing produced satisfactory results in patients with rheumatoid arthritis.

Résultats à moyen terme de la prothése totale du genou Wallaby I ® conservant le ligament croisé postérieur : À propos des 425 premiers cas suivis prospectivement

Purpose of the study Posterior Wallaby I ® is a fixed polyethylene tibial plateau prosthesis enabling preservation of the posterior cruciate ligament (PCL). Its asymmetrical and divergent femoral condyles articulate with also asymmetrical tibial plateaus. The purpose of this prospective study was to analyze outcome of the first 425 Wallaby I ® prosthesis of the Guepar group implanted for first-intention treatment. Materials and methods These 425 prostheses were implanted from December 1992 to February 1995 by senior and junior surgeons. Mean patient age at implantation was 70.5 years. 91% had primary or secondary osteoarthritis and only 8.9% had inflammatory rheumatoid disease. The mean preoperative IKS score was 25.34 points and the IKS function score was 29.04. 10.35% of knees were aligned normally (mechanical axis between 2° varus and 3° valgus) according to the IKS criteria (Ewald), 24% presented valgus ≥ 4° and 65.6% varus ≥ 3°. All tibial and patellar components (except one) were cemented, 5.8% of the femoral pieces were inserted without cement. All but 11 patellae were resurfaced. Clinical outcome was assessed with the IKS score and radiological outcome with the IKS criteria. The patella was considered to be tilted when the alpha angle was > 5° and dislocated when the AA’ distance was > 5 mm. The chi-square test was used for comparison of quantitative variables (significance set at 0.05). Results Early postoperative complications were rare: two infections cured with debridement-lavage and antibiotics without removal of the prosthesis, one peronal nerve palsy which regressed partially, ten late unions without clinical consequence (particularly in the inflammatory rheumatoid patients). Twenty-six prostheses were followed less than one year (eight patients died and eighteen were lost to follow-up) and 84 less than five years (27 patients died and 57 lost to follow-up before five years). 315 prostheses were followed for more than five years (5-9 years) with a mean follow-up of 6.3 years. Among the 399 prostheses followed for one year or more, we noted: four infections including three requiring change of the prosthesis (one cured by arthroscopic lavage), two aseptic loosenings which were revised (one global one tibial), one tibial loosening and three patellar loosenings which were not revised, and two femoral ossifications limiting joint motion but improved by arthrolysis and resection of the ossifications. Three patients experienced anterior pain requiring secondary patellar resurfacing in two and section of the lateral patellar wing in one. Ninteen patellar fractures (4.7%) were noted, including 17 with no significant functional impact which were not revised. The mean IKS knee score among prostheses followed for five years was 90.5 points, with mean motion 110.5°. Mean IKS function score was 61.63 points. 72.9% of the knees were aligned, 22.2% in varus and 4.9% in valgus. The mechanical axis of 94.3% of the knees was between 5° varus and 5° valgus. Prosthesis survival at eight years (Kaplan-Meier method) was 97.7% considering all reasons for prosthesis removal and 98.5% for removal for aseptic loosening. Conclusion This prospective multicentric study demonstrated that the results obtained with the Wallaby I ® prosthesis are as good as those obtained with other prostheses sparing the PCL and published in the literature. Preservation of the PCL enables better knee stability, correct motion (110.5° in our series) with almost no radiological wear of the tibial polyethylene at eight years. The only worrisome complication is patellar fracture.

Secondary Resurfacing of the Patella in Mobile-Bearing Total Knee Arthroplasty

Objective: We aim to evaluate the impact of secondary patellar resurfacing in patients with patellar-related anterior knee pain who have undergone a mobile-bearing primary knee arthroplasty without resurfacing. Materials: A total of 2950 primary Low Contact Stress (DePuy, Warsaw, Ind) mobile-bearing knee arthroplasties without patellar resurfacing were carried out between March 1992 and March 2003. Thirteen patients (0.4%) underwent secondary patellar resurfacing for patellar-related anterior knee pain. The mean age of the patients was 67.8 years. There was a mean time of 28 months to the secondary resurfacing procedure. Results: Only 4 patients had an unequivocal improvement in their symptoms at a mean follow-up of 45 months (range, 3-92 months). No morbidity was noted from the procedure. Conclusion: The success rate of secondary patellar resurfacing is poor and patients should be counseled carefully.

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.

Selective Patellar Nonresurfacing in Total Knee Arthroplasty 10 Year Results

Patella nonresurfacing in total knee arthroplasty was reviewed retrospectively in 49 knees (42 patients). Thirteen patients (17 knees) died leaving 29 patients (32 knees) in the final study group. The minimum length of followup was 10 years and averaged 11.7 years (range, 10-13.4 years). The diagnosis was primary osteoarthritis in 26 knees, posttraumatic arthritis in four, osteonecrosis in one, and Paget's disease in one. Patients were evaluated using the Knee Society score, a patella score, and radiographs. The mean Knee Society score improved from 52.8 to 87.5 points postoperatively and functional score improved from 57.5 to 84.5 points postoperatively. Anterior knee pain was reported in six knees (20%). Only one patient required secondary resurfacing of the patella because of postoperative anterior knee pain. No significant correlation was found between anterior knee pain and patellofemoral joint space, patellar sclerosis, Insall-Salvati ratio, patellar tilt, gender, obesity, or age. Based on the need for secondary patellar resurfacing because of anterior knee pain, the 10-year survival was 97.5%. At minimum 10-year followup, retaining the patella in total knee arthroplasty in selected patients with osteoarthritis of the osteoarthritic knee can yield acceptable results.