Comparison between Patellar Resurfacing and Retention in Total Knee Arthroplasty Regarding the Postoperative Satisfaction of Patients and Patellar Crepitus

Document Type: RESEARCH PAPER

Authors

1 Tehran University of Medical Sciences, Tehran, Iran

2 Tehran University of Medical Sciences

3 Imam Khomeini Hospital Complex Orthopedic Surgury Department, Medical Faculty, Tehran Univercity, Iran

Abstract

Background: Patellar crepitus after total knee arthroplasty (TKA) is not uncommon. The choice between patellar
resurfacing or retention in TKA has remained controversial. Therefore, this randomized controlled trial aimed to evaluate
the impact of patellar resurfacing on the incidence of patellar crepitus. In addition, we compared the clinical outcomes
and satisfaction between the patients who underwent patellar retention or resurfacing.
Methods: A total of 63 patients randomly received patellar resurfacing or non-resurfacing TKA by one surgeon at Imam
Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran during May 2014-February 2017. Finally,
29 patients in the resurfaced group and 44 subjects with retained patella were evaluated pre-op and in an average
follow-up period of 8.68 months using the clinical Knee Society Score (KSS), functional KSS, and Knee injury and
Osteoarthritis Outcome Score (KOOS).
Results: Our findings demonstrated no significant difference between the two groups regarding the satisfaction
of patients, KSS, and KOOS. It was shown that the latter scores improved in both groups in the follow-up period.
Nonetheless, patellar crepitus was not statistically different between the two groups.
Conclusion: According to the results of the present study, patellar resurfacing did not lead to decreased patellar
crepitus or enhanced clinical outcomes of TKA.
Level of evidence: I

Keywords

Main Subjects


1. Cameron HU, Jung YB. A comparison of
unicompartmental knee replacement with total knee
replacement. Orthop Rev. 1988; 17(10):983-8.
2. Heck DA, Marmor L, Gibson A, Rougraff BT.
Unicompartmental knee arthroplasty. A multicenter
investigation with long-term follow-up evaluation.
Clin Orthop Relat Res. 1993; 286(1):154-9.
3. Barrett WP, Scott RD. Revision of failed unicondylar
unicompartmental knee arthroplasty. J Bone Joint
Surg Am. 1987; 69(9):1328-35.
4. 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(1):12-25.
5. Hernigou P, Deschamps G. Patellar impingement
following unicompartmental arthroplasty. J Bone
Joint Surg Am. 2002; 84(7):1132-7.

6. Dalury DF, Ewald FC, Christie MJ, Scott RD. Total knee
arthroplasty in a group of patients less than 45 years
of age. J Arthroplasty. 1995; 10(5):598-602.
7. Garneti N, Mahadeva D, Khalil A, McLaren CA. Patellar
resurfacing versus no resurfacing in Scorpio total
knee arthroplasty. J Knee Surg. 2008; 21(2):97-100.
8. Dennis DA, Kim RH, Johnson DR, Springer BD, Fehring
TK, Sharma A. The John Insall Award: controlmatched
evaluation of painful patellar Crepitus after
total knee arthroplasty. Clin Orthop Relat Res. 2011;
469(1):10-7.
9. Ranawat AS, Ranawat CS, Slamin JE, Dennis DA.
Patellar crepitation in the P.F.C. sigma total knee
system. Orthopedics. 2006; 29(9 Suppl):S68-70.
10. Beight JL, Yao B, Hozack WJ, Hearn SL, Booth RE Jr. The
patellar “clunk” syndrome after posterior stabilized
total knee arthroplasty. Clin Orthop Relat Res. 1994;
299(1):139-42.

11. Hozack WJ, Rothman RH, Booth RE Jr, Balderston
RA. The patellar clunk syndrome. A complication
of posterior stabilized total knee arthroplasty. Clin
Orthop Relat Res. 1989; 241(1):203-8.
12. Ip D, Ko PS, Lee OB, Wu WC, Lam JJ. Natural history
and pathogenesis of the patella clunk syndrome. Arch
Orthop Trauma Surg. 2004; 124(9):597-602.
13. Larson CM, Lachiewicz PF. Patellofemoral
complications with the Insall-Burstein II posteriorstabilized
total knee arthroplasty. J Arthroplasty.
1999; 14(3):288-92.
14. Lonner JH, Jasko JG, Bezwada HP, Nazarian DG, Booth
RE Jr. Incidence of patellar clunk with a modern
posterior-stabilized knee design. Am J Orthop (Belle
Mead NJ). 2007; 36(10):550-3.
15. Pollock DC, Ammeen DJ, Engh GA. Synovial
entrapment: a complication of posterior stabilized
total knee arthroplasty. J Bone Joint Surg Am. 2002;
84(12):2174-8.
16. Schroer WC, Diesfeld PJ, Reedy ME, LeMarr A.
Association of increased knee flexion and patella
clunk syndrome after mini-subvastus total knee
arthroplasty. J Arthroplasty. 2009; 24(2):281-7.
17. Yau WP, Wong JW, Chiu KY, Ng TP, Tang WM. Patellar
clunk syndrome after posterior stabilized total knee
arthroplasty. J Arthroplasty. 2003; 18(8):1023-8.
18. Fukunaga K, Kobayashi A, Minoda Y, Iwaki H,
Hashimoto Y, Takaoka K. The incidence of the patellar
clunk syndrome in a recently designed mobilebearing
posteriorly stabilised total knee replacement.
J Bone Joint Surg Br. 2009; 91(4):463-8.
19. Shillington MP, Cashman K, Farmer G. Patellofemoral
crepitus in high flexion rotating platform knee
arthroplasty. ANZ J Surg. 2013; 83(10):779-83.
20. Ogawa H, Matsumoto K, Akiyama H. Effect of patellar
resurfacing on patellofemoral crepitus in posteriorstabilized
total knee arthroplasty. J Arthroplasty.
2016; 31(8):1792-6.
21. Waters TS, Bentley G. Patellar resurfacing in total
knee arthroplasty. A prospective, randomized study. J
Bone Joint Surg Am. 2003; 85(2):212-7.
22. 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.
23. Bourne RB, Burnett RS. The consequences of not
resurfacing the patella. Clin Orthop Relat Res. 2004;
428(1):166-9.

24. Forster MC. Patellar resurfacing in total knee
arthroplasty for osteoarthritis: a systematic review.
Knee. 2004; 11(6):427-30.
25. Li S, Chen Y, Su W, Zhao J, He S, Luo X. Systematic review
of patellar resurfacing in total knee arthroplasty. Int
Orthop. 2011; 35(3):305-16.
26. 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.
27. Pakos EE, Ntzani EE, Trikalinos TA. Patellar resurfacing
in total knee arthroplasty. A meta-analysis. J Bone
Joint Surg Am. 2005; 87(7):1438-45.
28. 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.
29. 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(1):65-72.
30. 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 Br. 2006; 88(6):734-9.
31. Smith AJ, Wood DJ, Li MG. Total knee replacement
with and without patellar resurfacing: a prospective,
randomised trial using the profix total knee system. J
Bone Joint Surg Br. 2008; 90(1):43-9.
32. Waikakul S, Vanadurongwan V, Bintachitt P. The effects
of patellar resurfacing in total knee arthroplasty on
position sense: a prospective randomized study. J Med
Assoc Thai. 2000; 83(9):975-82.
33. 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(2):187-93.
34. Colizza WA, Insall JN, Scuderi GR. The posterior
stabilized total knee prosthesis. Assessment of
polyethylene damage and osteolysis after a ten-yearminimum
follow-up. J Bone Joint Surg Am. 1995;
77(11):1713-20.
35. Martin JR, Jennings JM, Watters TS, Levy DL, McNabb
DC, Dennis DA. Femoral implant design modification
decreases the incidence of patellar crepitus in total
knee arthroplasty. J Arthroplasty. 2017; 32(4):1310-3.