Patellar resurfacing in total knee arthroplasty for osteoarthritis: a meta-analysis

Whether to resurface the patella during a primary total knee arthroplasty remains a controversial issue. The aim of this study was to determine the advantages and disadvantages of patellar resurfacing during total knee arthroplasty for osteoarthritis through an evaluation of the current literature.

A meta-analysis of randomized controlled trials comparing patellar resurfacing with nonresurfacing during total knee arthroplasties was performed. The focus of this analysis was on outcomes of reoperation, anterior knee pain and knee scores.

Ten trials assessing 1,003 knees were eligible. The absolute risk of reoperation was reduced by 4% (95% confidence interval, 1–7%) in the patellar resurfacing arm (between-study heterogeneity, P = 0.06, I ² = 45%), implying that one would have to resurface 25 patellae (95% confidence interval, 14–100 patellae) in order to prevent one reoperation. Only seven trials provided adequate data of anterior knee pain for a quantitative synthesis. On the basis of those seven trials, there was no difference between the two groups in terms of anterior knee pain. Anterior knee pain after total knee arthroplasty could have multiple etiologies such as surgical factors and nonresurfaced patella is not the sole cause of this problem.

The available evidence indicates that patellar resurfacing reduce the risk of reoperation after total knee arthroplasty for osteoarthritis. Not resurfacing the patella might be considered a reasonable option, but patients must accept the increased risk of reoperation for which the quantitative evidence-based synthesis is mild. Based on the evidence provided by this study and those previously published ones, the authors do not now resurface the patella as a matter of routine for patients having a primary total knee arthroplasty for osteoarthritis.

Therapeutic study (Systematic review of Level-I studies with inconsistent results), Level II.