Document Type: RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Orthopedic Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Orthopedic Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Abstract

Background: There is no difference in the functional outcomes 6 months after total knee arthroplasty (TKA) for knee
osteoarthritis between patellar resurfacing and non-resurfacing. Thus, we have performed this study to compare the
short-term clinical outcomes of TKA performed with and without the patella resurfacing.
Methods: A total of 50 patients with osteoarthritis of the knee (OAK) were randomized to receive patellar resurfacing
(n=24; resurfaced group) or to retain their native patella (n=26; non-resurfaced group) based on envelope selection
and provided informed consent. Disease specific outcomes including Knee Society Score (KSS), Knee Society
Function Score (KSKS-F), Kujala Anterior Knee Pain Scale (AKPS), Western Ontario and McMaster Universities
Arthritis Index (WOMAC), Short Form 36 (SF-36), and functional patella-related activities were measured within six
months of follow-up.
Results: There was no significant difference between the resurfaced and non-resurfaced groups in pre and postoperative
improvement of range of motion (ROM) (P=0.421), KSS (P=0.782, P=0.553), KSKS-F (P=0.241, P=0.293),
AKPS (P=0.128, P=0.443), WOMAC (P=0.700, P=0.282), and pain scores (P=0.120, P=0.508). There was no
difference in ROM between resurfaced and non-resurfaced group pre (15.24° and 15.45°) and post-operative (18.48°
and 18.74). No side effects related to patella was observed in any of the groups. Revision was required in none of
the participants.
Conclusion: The results showed no significant difference between patellar resurfacing and non-resurfacing in TKA for
all outcome measures in a short term.

Keywords

Main Subjects

1. 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-A(2):187-93.
2. Forster MC. Patellar resurfacing in total knee
arthroplasty for osteoarthritis: a systematic review.
Knee. 2004; 11(6):427-30.
3. Sobhan MR, Mehdinejad M, Jamaladini MH, Mazaheri
M, Zare-Shehneh M, Neamatzadeh H. Association
between aspartic acid repeat polymorphism of
the asporin gene and risk of knee osteoarthritis: a
systematic review and meta-analysis. Acta Orthop
Traumatol Turc. 2017; 51(5):409-15.
4. Yazdi MM, Jamalaldini MH, Sobhan MR, Jafari M,
Mazaheri M, Zare-Shehneh M, et al. Association
of ESRα gene Pvu II T>C, XbaI A>G and BtgI
G>A polymorphisms with knee osteoarthritis
susceptibility: a systematic review and meta-analysis
based on 22 case-control studies. Arch Bone Jt Surg.
2017; 5(6):351-62.
5. Barrack RL, Wolfe MW. Patellar resurfacing in total
knee arthroplasty. J Am Acad Orthopaed Surg. 2000;
8(2):75-82.
6. Fu Y, Wang G, Fu Q. Patellar resurfacing in total knee
arthroplasty for osteoarthritis: a meta-analysis. Knee
Surg Sports Traumatol Arthrosc. 2011; 19(9):1460-6.
7. He JY, Jiang LS, Dai LY. Is patellar resurfacing superior
than nonresurfacing in total knee arthroplasty? A
meta-analysis of randomized trials. Knee. 2011;
18(3):137-44.
8. Epinette JA, Manley MT. Outcomes of patellar
resurfacing versus nonresurfacing in total knee
arthroplasty: a 9-year experience based on a case
series of scorpio PS knees. J Knee Surg. 2008;
21(4):293-8.
9. Ong K, Lau E, Manley M, Kurtz SM. Patient, hospital,
and procedure characteristics influencing total
hip and knee arthroplasty procedure duration. J
Arthroplasty. 2009; 24(6):925-31.
10. Huang CH, Liau JJ, Ho FY, Lin CY, Young TH, Cheng CK.
Polyethylene failure of the patellar component in New
Jersey low-contact stress total knee arthroplasties. J
Arthroplasty. 2005; 20(2):202-8.
11. Ortiguera CJ, Berry DJ. Patellar fracture after total
knee arthroplasty. J Bone Joint Surg Am. 2002; 84-
A(4):532-40.
12. Newman JH, Ackroyd CE, Shah NA, Karachalios T.
Should the patella be resurfaced during total knee
replacement? Knee. 2000; 7(1):17-23.
13. Waters TS, Bentley G. Patellar resurfacing in total
knee arthroplasty. A prospective, randomized study. J
Bone Joint Surg Am. 2003; 85-A(2):212-7.
14. Kim BS, Reitman RD, Schai PA, Scott RD. Selective
patellar nonresurfacing in total knee arthroplasty.
10 year results. Clin Orthop Relat Res. 1999;
367(1):81-8.
15. 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(11):2562-7.
16. Campbell DG, Duncan WW, Ashworth M, Mintz A,
Stirling J, Wakefield L, et al. Patellar resurfacing in total
knee replacement: a ten-year randomised prospective
trial. J Bone Joint Surg Am. 2006; 88(6):734-9.
17. Bourne RB, Burnett RS. The consequences of not
resurfacing the patella. Clin Orthop Relat Res. 2004;
428(1):166-9.

18. 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(9):1261-70.
19. Li S, Chen Y, Su W, Zhao J, He S, Luo X. Systematic review
of patellar resurfacing in total knee arthroplasty. Int
Orthopaed. 2011; 35(3):305-16.
20. Pavlou G, Meyer C, Leonidou A, As-Sultany M,
West R, Tsiridis E. Patellar resurfacing in total
knee arthroplasty: does design matter? A metaanalysis
of 7075 cases. J Bone Joint Surg Am. 2011;
93(14):1301-9.
21. Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing
versus retention in total knee arthroplasty. J Bone
Joint Surg Br. 1996; 78(2):226-8.
22. Parry MC, Smith AJ, Blom AW. Early death following
primary total knee arthroplasty. J Bone Joint Surg Am.
2011; 93(10):948-53.
23. van Jonbergen H, Scholtes V, van Kampen A, Poolman
RW. A randomised, controlled trial of circumpatellar
electrocautery in total knee replacement without
patellar resurfacing. J Bone Joint Surg. 2011;
98(3):1054-9.
24. Schroeder-Boersch H, Scheller G, Fischer J, Jani L.
Advantages of patellar resurfacing in total knee
arthroplasty. Two-year results of a prospective
randomized study. Arch Orthop Trauma Surg. 1998;
117(1-2):73-8.
25. Nizard RS, Biau D, Porcher R, Ravaud P, Bizot P,
Hannouche D, et al. A meta-analysis of patellar
replacement in total knee arthroplasty. Clin Orthop
Relat Res. 2005; 432(1):196-203.
26. 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(1):191-6.
27. Meftah M, Ranawat AS, Ranawat CS. Ten-year followup
of a rotating-platform, posterior-stabilized total
knee arthroplasty. J Bone Joint Surg Am. 2012;
94(5):426-32.
28. Arirachakaran A, Sangkaew C, Kongtharvonskul J.
Patellofemoral resurfacing and patellar denervation
in primary total knee arthroplasty. Knee Surg Sports
Traumatol Arthrosc. 2015; 23(6):1770-81.
29. Metsna V, Vorobjov S, Martson A. Prevalence of
anterior knee pain among patients following total
knee arthroplasty with nonreplaced patella: a
retrospective study of 1778 knees. Medicina. 2014;
50(2):82-6.
30. van Hemert WL, Senden R, Grimm B, Kester AD, van
der Linde MJ, Heyligers IC. Patella retention versus
replacement in total knee arthroplasty; functional
and clinometric aspects. Arch Orthop Trauma Surg.
2009; 129(2):259-65.
31. Beaupre L, Secretan C, Johnston DW, Lavoie G. A
randomized controlled trial comparing patellar
retention versus patellar resurfacing in primary total
knee arthroplasty: 5-10 year follow-up. BMC Res
Notes. 2012; 5(1):273.
32. Pilling RW, Moulder E, Allgar V, Messner J, Sun Z,
Mohsen A. Patellar resurfacing in primary total knee
replacement: a meta-analysis. J Bone Joint Surg Am.
2012; 94(24):2270-8.
33. Meneghini RM. Should the patella be resurfaced in
primary total knee arthroplasty? An evidence-based
analysis. J Arthroplasty. 2008; 23(7 Suppl):11-4.
34. 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(1):156-61.
35. Bae DK, Cho SD, Im SK, Song SJ. Comparison of
midterm clinical and radiographic results between
total knee arthroplasties using medial pivot and
posterior-stabilized prosthesis-a matched pair
analysis. J Arthroplasty. 2016; 31(2):419-24.
36. Bach CM, Mayr E, Liebensteiner M, Gstottner M,
Nogler M, Thaler M. Correlation between radiographic
assessment and quality of life after total knee
arthroplasty. Knee. 2009; 16(3):207-10.