Top

Clinical Orthopaedics and Related Research®

Published in:

01-01-2012 | Symposium: Papers Presented at the Annual Meetings of The Knee Society

Revision Surgery for Patellofemoral Problems: Should We Always Resurface?

Authors: Todd C. Johnson, MD, Penny J. Tatman, MPH, Susan Mehle, BS, Terence J. Gioe, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 1/2012

Abstract

Background

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.

Questions/purposes

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.

Patients and Methods

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.

Results

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%.

Conclusions

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.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Barrack RL, Bertot AJ, Wolfe MW, Waldman DA, Milicic M, Myers L. Patellar resurfacing in total knee arthroplasty: a prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Am. 2001;83:1376–1381.PubMed

Berry DJ, Bozic KJ. Current practice patterns in primary hip and knee arthroplasty among members of the American Association of Hip and Knee Surgeons. J Arthroplasty. 2010;25(6 Suppl):2–4.PubMedCrossRef

Bourne RB, Burnett RS. The consequences of not resurfacing the patella. Clin Orthop Relat Res. 2004;428:166–169.PubMedCrossRef

Bourne RB, Rorabeck CH, Vaz M, Kramer J, Hardie R, Robertson D. Resurfacing versus not resurfacing the patella during total knee replacement. Clin Orthop Relat Res. 1995;321:156–161.PubMed

Burnett RS, Boone JL, McCarthy KP, Rosenzweig S, Barrack RL. A prospective randomized clinical trial of patellar resurfacing and nonresurfacing in bilateral TKA. Clin Orthop Relat Res. 2007;464:65–72.PubMed

Burnett RS, Boone JL, Rosenzweig SD, Steger-May K, Barrack RL. Patellar resurfacing compared with nonresurfacing in total knee arthroplasty: a concise follow-up of a randomized trial. J Bone Joint Surg Am. 2009;91:2562–2567.PubMedCrossRef

Burnett RS, Haydon CM, Rorabeck CH, Bourne RB. Patella resurfacing versus nonresurfacing in total knee arthroplasty: results of a randomized controlled clinical trial at a minimum of 10 years’ followup. Clin Orthop Relat Res. 2004;428:12–25.PubMedCrossRef

Calvisi V, Camillieri G, Lupparelli S. Resurfacing versus nonresurfacing the patella in total knee arthroplasty: a critical appraisal of the available evidence. Arch Orthop Trauma Surg. 2009;129:1261–1270.PubMedCrossRef

Campbell DG, Duncan WW, Ashworth M, Mintz A, Stirling J, Wakefield L, Stevenson TM. Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. J Bone Joint Surg Br. 2006;88:734–739.PubMedCrossRef

10.

Clements WJ, Miller L, Whitehouse SL, Graves SE, Ryan P, Crawford RW. Early outcomes of patella resurfacing in total knee arthroplasty. Acta Orthop. 2010;81:108–113.PubMedCrossRef

11.

Gioe TJ, Killeen KK, Mehle S, Grimm K. Implementation and application of a community total joint registry: a twelve-year history. J Bone Joint Surg Am. 2006;88:1399–1404.PubMedCrossRef

12.

Healy WL, Wasilewski SA, Takei R, Oberlander M. Patellofemoral complications following total knee arthroplasty: correlation with implant design and patient risk factors. J Arthroplasty. 1995;10:197–201.PubMedCrossRef

13.

Helmy N, Anglin C, Greidanus NV, Masri BA. To resurface or not to resurface the patella in total knee arthroplasty. Clin Orthop Relat Res. 2008;466:2775–2783.PubMedCrossRef

14.

Khatod M, Codsi M, Bierbaum B. Results of resurfacing a native patella in patients with a painful total knee arthroplasty. J Knee Surg. 2004;17:151–155.PubMed

15.

Lindstrand A, Robertsson O, Lewold S, Toksvig-Larsen S. The patella in total knee arthroplasty: resurfacing or nonresurfacing of patella. Knee Surg Sports Traumatol Arthrosc. 2001;9(Suppl 1):S21–S23.PubMedCrossRef

16.

Matsuda S, Ishinishi T, Whiteside LA. Contact stresses with an unresurfaced patella in total knee arthroplasty: the effect of femoral component design. Orthopedics. 2000;23:213–218.PubMed

17.

Mayman D, Bourne RB, Rorabeck CH, Vaz M, Kramer J. Resurfacing versus not resurfacing the patella in total knee arthroplasty: 8- to 10-year results. J Arthroplasty. 2003;18:541–545.PubMedCrossRef

18.

Muoneke HE, Khan AM, Giannikas KA, Hagglund E, Dunningham TH. Secondary resurfacing of the patella for persistent anterior knee pain after primary knee arthroplasty. J Bone Joint Surg Br. 2003;85:675–678.PubMed

19.

Myles CM, Rowe PJ, Nutton RW, Burnett R. The effect of patella resurfacing in total knee arthroplasty on functional range of movement measured by flexible electrogoniometry. Clin Biomech (Bristol, Avon). 2006;21:733–739.CrossRef

20.

Newman JH, Ackroyd CE, Shah NA, Karachalios T. Should the patella be resurfaced during total knee replacement? Knee. 2000;7:17–23.CrossRef

21.

Nizard RS, Biau D, Porcher R, Ravaud P, Bizot P, Hannouche D, Sedel L. A meta-analysis of patellar replacement in total knee arthroplasty. Clin Orthop Relat Res. 2005;432:196–203.PubMedCrossRef

22.

Pakos EE, Ntzani EE, Trikalinos TA. Patellar resurfacing in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am. 2005;87:1438–1445.PubMedCrossRef

23.

Parvizi J, Rapuri VR, Saleh KJ, Kuskowski MA, Sharkey PF, Mont MA. Failure to resurface the patella during total knee arthroplasty may result in more knee pain and secondary surgery. Clin Orthop Relat Res. 2005;438:191–196.PubMedCrossRef

24.

Peng CW, Tay BK, Lee BP. Prospective trial of resurfaced patella versus non-resurfaced patella in simultaneous bilateral total knee replacement. Singapore Med J. 2003;44:347–351.PubMed

25.

Robertsson O, Bizjajeva S, Fenstad AM, Furnes O, Lidgren L, Mehnert F, Odgaard A, Pedersen AB, Havelin LI. Knee arthroplasty in Denmark, Norway and Sweden. Acta Orthop. 2010;81:82–89.PubMedCrossRef

26.

Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand. 2000;71:262–267.PubMedCrossRef

27.

Tanzer M, McLean CA, Laxer E, Casey J, Ahmed AM. Effect of femoral component designs on the contact and tracking characteristics of the unresurfaced patella in total knee arthroplasty. Can J Surg. 2001;44:127–133.PubMed

28.

Waters TS, Bentley G. Patellar resurfacing in total knee arthroplasty: a prospective, randomized study. J Bone Joint Surg Am. 2003;85:212–217.PubMed

29.

Whiteside LA. Patella resurfacing no longer considered routine in TKA: counterpoint. Orthopedics. 2006;29:833–835.PubMed

30.

Whiteside LA, Nakamura T. Effect of femoral component design on unresurfaced patellas in knee arthroplasty. Clin Orthop Relat Res. 2003;410:189–198.PubMedCrossRef

31.

Wood DJ, Smith AJ, Collopy D, White B, Brankov B, Bulsara MK. Patellar resurfacing in total knee arthroplasty: a prospective, randomized trial. J Bone Joint Surg Am. 2002;84:187–193.PubMed

Title: Revision Surgery for Patellofemoral Problems: Should We Always Resurface?
Authors: Todd C. Johnson, MD
Penny J. Tatman, MPH
Susan Mehle, BS
Terence J. Gioe, MD
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 1/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-2036-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Revision Surgery for Patellofemoral Problems: Should We Always Resurface?

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 1/2012

Patient-related Risk Factors for Postoperative Mortality and Periprosthetic Joint Infection in Medicare Patients Undergoing TKA

Restoration of the Distal Femur Impacts Patellar Height in Revision TKA

Navigation-assisted Surgery for Bone and Soft Tissue Tumors With Bony Extension

Improved Accuracy of Alignment With Patient-specific Positioning Guides Compared With Manual Instrumentation in TKA

Mark B. Coventry Award: Synovial C-reactive Protein: A Prospective Evaluation of a Molecular Marker for Periprosthetic Knee Joint Infection

Papers Presented at the Annual Meetings of the Knee Society: Editorial Comment