Top

International Orthopaedics

Published in:

Open Access 01-11-2019 | Knee Osteoarthritis | Original Paper

Resurfacing versus not-resurfacing the patella in one-stage bilateral total knee arthroplasty: a prospective randomized clinical trial

Authors: Chengzhi Ha, Baoxin Wang, Wei Li, Kang Sun, Dawei Wang, Qicai Li

Published in: International Orthopaedics | Issue 11/2019

Abstract

Purpose

Resurfacing the patella in one-stage bilateral total knee arthroplasty (TKA) remains debatable. This study aimed to assess the mid-term outcomes of patients after one-stage bilateral TKA performed with and without patellar resurfacing, respectively, with at least five years of follow-up.

Methods

Sixty-six patients (132 knees) scheduled for first-ever one-stage bilateral TKA due to osteoarthritis received patellar resurfacing and retention, respectively, on one knee and the other, randomly selected. All patients received Scorpio NRG knee prostheses and were evaluated by radiology (anteroposterior, lateral, and axial views) pre-operatively and yearly post-operatively, for at least five years. Knee Society Score and Feller Score values were measured. Anterior knee pain, patellar clunk, and patient satisfaction were assessed.

Results

One patient died within five years of operation and four were lost to follow-up. One patient developed severe dementia and could not be constructively questioned. Therefore, 60 patients (120 knees) were finally analyzed. There were significantly improved Knee Society and Feller scores (P < 0.001) in the resurfacing group compared with the non-resurfacing group post-operatively. Anterior knee pain and patellar clunk rates were lower on the resurfaced side compared with the non-resurfaced side (P < 0.001). Meanwhile, 47% and only 7% patients preferred the resurfaced and non-resurfaced sides, respectively, at final follow-up. No revision was performed for patellofemoral complications, and no significant differences were found between the two groups in radiographic outcomes.

Conclusions

Using the Scorpio NRG knee prosthesis, patellar resurfacing is superior to non-resurfacing in patients with osteoarthritis observed for ≥ five years.

Registration trials number

NCT03600922

Key Points

• Findings Patellar resurfacing is superior to non-resurfacing in osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA) with the Scorpio NRG knee prosthesis.

• Implications Patellar resurfacing should be performed in OA patients during TKA.

• Caution Several prosthesis types should be assessed in the same study setting, and multicenter studies are required before generalizability of the present findings.

Available only for authorised users

Shukla D, Sreedhar SK, Rastogi V (2018) A comparative study of botulinum toxin: a with triamcinolone compared to triamcinolone alone in the treatment of osteoarthritis of knee. Anesth Essays Res 12(1):47–49. https://doi.org/10.4103/aer.AER_210_17 CrossRefPubMedPubMedCentral

Beaupre LA, Sharifi B, Johnston DWC (2017) A randomized clinical trial comparing posterior cruciate-stabilizing vs posterior cruciate-retaining prostheses in primary total knee arthroplasty: 10-year follow-up. J Arthroplast 32(3):818–823. https://doi.org/10.1016/j.arth.2016.08.030 CrossRef

Grassi A, Compagnoni R, Ferrua P, Zaffagnini S, Berruto M, Samuelsson K, Svantesson E, Randelli P (2018) Patellar resurfacing versus patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses. Knee Surg Sports Traumatol Arthros. https://doi.org/10.1007/s00167-018-4831-8 CrossRef

Harato K, Tanikawa H, Morishige Y, Kaneda K, Niki Y (2016) What are the important surgical factors affecting the wound healing after primary total knee arthroplasty? J Orthop Surg Res 11:7. https://doi.org/10.1186/s13018-016-0340-y CrossRefPubMedPubMedCentral

Tang XB, Wang J, Dong PL, Zhou R (2018) A meta-analysis of patellar replacement in total knee arthroplasty for patients with knee osteoarthritis. J Arthroplast 33(3):960–967. https://doi.org/10.1016/j.arth.2017.10.017 CrossRef

Mutsuzaki H, Watanabe A, Komatsuzaki T, Kinugasa T, Ikeda K (2018) Investigation of perioperative safety and clinical results of one-stage bilateral total knee arthroplasty in selected low-risk patients. J Orthop Surg Res 13(1):14. https://doi.org/10.1186/s13018-018-0720-6 CrossRefPubMedPubMedCentral

Petersen W, Rembitzki IV, Bruggemann GP, Ellermann A, Best R, Koppenburg AG, Liebau C (2014) Anterior knee pain after total knee arthroplasty: a narrative review. Int Orthop 38(2):319–328. https://doi.org/10.1007/s00264-013-2081-4 CrossRefPubMed

Bi X (2006) Total knee arthroplasty rehabilitation guide. Shanghai Science and Technology Publishing & Distribution Co, Shanghai

Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res (248):13–14

10.

Feller JA, Bartlett RJ, Lang DM (1996) Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br 78(2):226–228CrossRef

11.

Johnson EW (2001) Visual analog scale (VAS). American journal of physical medicine & rehabilitation 80(10):717CrossRef

12.

Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–191CrossRef

13.

Antholz CR, Cherian JJ, Elmallah RK, Jauregui JJ, Pierce TP, Mont MA (2015) Selective patellar resurfacing: a literature review. Surgical technology international 26:355–360PubMed

14.

Waters TS, Bentley G (2003) Patellar resurfacing in total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am 85-A(2):212–217CrossRef

15.

Kordelle J, Schleicher I, Kaltschmidt I, Haas H, Gruner MR (2003) Patella resurfacing in patients without substantial retropatellar knee pain symptoms? Z Orthop Ihre Grenzgeb 141(5):557–562. https://doi.org/10.1055/s-2003-42850 CrossRefPubMed

16.

Arbuthnot JE, McNicholas MJ, McGurty DW, Rowley DI (2004) Total knee replacement and patellofemoral pain. Surgeon 2(4):230–233CrossRef

17.

Patel K, Raut V (2011) Patella in total knee arthroplasty: to resurface or not to--a cohort study of staged bilateral total knee arthroplasty. Int Orthop 35(3):349–353. https://doi.org/10.1007/s00264-010-1063-z CrossRefPubMed

18.

Hozack WJ, Rothman RH, Booth RE Jr, Balderston RA (1989) The patellar clunk syndrome. A complication of posterior stabilized total knee arthroplasty. Clin Orthop Relat Res (241):203–208

19.

Daniilidis K, Vogt B, Gosheger G, Henrichs M, Dieckmann R, Schulz D, Hoell S (2012) Patellar resurfacing as a second stage procedure for persistent anterior knee pain after primary total knee arthroplasty. Int Orthop 36(6):1181–1183. https://doi.org/10.1007/s00264-011-1463-8 CrossRefPubMedPubMedCentral

20.

Maloney WJ, Schmidt R, Sculco TP (2003) Femoral component design and patellar clunk syndrome. Clin Orthop Relat Res 410:199–202. https://doi.org/10.1097/01.blo.0000063606.67412.96 CrossRef

21.

Frye BM, Floyd MW, Pham DC, Feldman JJ, Hamlin BR (2012) Effect of femoral component design on patellofemoral crepitance and patella clunk syndrome after posterior-stabilized total knee arthroplasty. J Arthroplast 27(6):1166–1170. https://doi.org/10.1016/j.arth.2011.12.009 CrossRef

22.

Costanzo JA, Aynardi MC, Peters JD, Kopolovich DM, Purtill JJ (2014) Patellar clunk syndrome after total knee arthroplasty; risk factors and functional outcomes of arthroscopic treatment. J Arthroplast 29(9 Suppl):201–204. https://doi.org/10.1016/j.arth.2014.03.045 CrossRef

23.

Snir N, Schwarzkopf R, Diskin B, Takemoto R, Hamula M, Meere PA (2014) Incidence of patellar clunk syndrome in fixed versus high-flex mobile bearing posterior-stabilized total knee arthroplasty. J Arthroplast 29(10):2021–2024. https://doi.org/10.1016/j.arth.2014.05.011 CrossRef

24.

Roessler PP, Moussa R, Jacobs C, Schuttler KF, Stein T, Schildberg FA, Wirtz DC (2018) Predictors for secondary patellar resurfacing after primary total knee arthroplasty using a “patella-friendly” total knee arthroplasty system. Int Orthop. https://doi.org/10.1007/s00264-018-4075-8 CrossRef

25.

Franck F, Ouanezar H, Jacquel A, Pibarot V, Wegrzyn J (2018) The predictive factors of secondary patellar resurfacing in computer-assisted total knee arthroplasty. A prospective cohort study. Int Orthop 42(5):1051–1060. https://doi.org/10.1007/s00264-017-3630-z CrossRefPubMed

26.

Prudhon JL, Caton JH, Aslanian T, Verdier R (2018) How is patella height modified after total knee arthroplasty? Int Orthop 42(2):311–316. https://doi.org/10.1007/s00264-017-3539-6 CrossRefPubMed

27.

Scheurer P, Reininga IH, van Jonbergen HP, van Raay JJ (2015) Secondary patellar resurfacing following total knee arthroplasty: a cohort study in fifty eight knees with a mean follow-up of thirty one months. Int Orthop 39(7):1301–1306. https://doi.org/10.1007/s00264-015-2684-z CrossRefPubMed

28.

Leta TH, Lygre SH, Skredderstuen A, Hallan G, Gjertsen JE, Rokne B, Furnes O (2016) Secondary patella resurfacing in painful non-resurfaced total knee arthroplasties : a study of survival and clinical outcome from the Norwegian arthroplasty register (1994-2011). Int Orthop 40(4):715–722. https://doi.org/10.1007/s00264-015-3017-y CrossRefPubMed

Title: Resurfacing versus not-resurfacing the patella in one-stage bilateral total knee arthroplasty: a prospective randomized clinical trial
Authors: Chengzhi Ha
Baoxin Wang
Wei Li
Kang Sun
Dawei Wang
Qicai Li
Publication date: 01-11-2019
Publisher: Springer Berlin Heidelberg
Keywords: Knee Osteoarthritis
Osteoarthrosis
Osteoarthrosis
Knee Osteoarthritis
Published in: International Orthopaedics / Issue 11/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-019-04361-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Resurfacing versus not-resurfacing the patella in one-stage bilateral total knee arthroplasty: a prospective randomized clinical trial

Abstract

Purpose

Methods

Results

Conclusions

Registration trials number

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Registration trials number

Key Points

Please log in to get access to this content

Other articles of this Issue 11/2019

Management of symptomatic os acromiale: a survey of the American shoulder and elbow surgeons

The optimization of the length of the lower limbs after hip arthroplasty

Cup alignment in total hip arthroplasty using the muscle-sparing modified Watson-Jones approach—comparison between lateral and supine positions

Comparison of custom cutting guides based on three-dimensional computerized CT-scan planning and a conventional ancillary system based on two-dimensional planning in total knee arthroplasty: a randomized controlled trial

Unicompartmental knee arthroplasty is superior to high tibial osteotomy in post-operative recovery and participation in recreational and sports activities

Diagnosing acute compartment syndrome—where have we got to?