Resurfacing Patella in 140 TKA Patients
Subgroup: Volume 12, Issue 1
Type: Letter to Editor
Start Page: 76
End Page: 78
- F Ghasemzadeh Department of Orthopedics,Iranian Hospital, Dubai, UAE
- C Mateescu Department of Research and Education, Iranian Hospital, Dubai, UAE
City, Province: Dubai,
Total knee arthroplasty (TKA) is a well-established procedure and has proven to be durable and effective for the treatment of advanced arthritis of the knee joint.1 The incorporation of patellar resurfacing during TKA reduces anterior knee pain but introduces new complications such as component failure, instability, fracture, tendon rupture and soft tissue impingement.2
The main reasons for resurfacing the patella are reduced anterior knee pain, reduced reoperation rate and deterioration, better results in patients with rheumatoid arthritis, better long-term functional outcome, poor results of resurfacing as a revision for previously non-resurfaced knees, poor correlation between intra-operative patellar cartilage and later anterior knee pain (AKP), better results in bilateral cases with one side resurfaced.1,2 The rate of complications after resurfacing the patella is still less than the rate of re-operation for AKP in non-resurfaced patella knees (NRS). The result of resurfacing for AKP in NRS knee is inferior to that of primary resurfacing.1,2 We aimed to evaluate the effectiveness of this technique through an evaluation of the current literature.
In our study, 140 cases that underwent primary TKA in the past 4 years in Iranian Hospital, Dubai, UAE were enrolled. All patients received the same total knee prosthetic components (Scorpio-Styker). During our first 105 cases, for only 2 cases we selected to perform patellar resurfacing, one of whom was a Tanzanian lady with valgus knee and subluxated patella and the other one, a Nigerian man who underwent TKA in another medical centre but referred to us after two years with shattered and dislocated patella. In the latter case, we did not only resurfaced the patella (Figure 1 and 2) but we performed lateral release and tibial tuberosity transfer (Figure 3 and 4).
Fig. 1: Shattered, broken, and dislocated patella after primary TKA
Fig. 2: Postoperative X-ray after tibial tuberosity transfer and lateral release and patellar resurfacing
Fig. 3: Merchant view of the fixed and resurfaced patella
Fig. 4: CT-scan of aligned and resurfaced patella
After our initial 105 cases and in an effort to reduce the complaints on anterior knee pain, instead of selective RS, we carried out routine RS in all recent 35 cases. With the number of available cases, in only 15% of our NRS cases, the patients complained of anterior knee pain in early postoperative period. The follow-up of NRS cases was about 22 months which was longer than the follow-up of RS cases (Average 6 months). Although the range of motion did not change significantly, but there were less complain of anterior knee pain.
Although the bulk of evidences are in favour of resurfacing but routine patellar resurfacing in TKA cannot be justified when a patella-friendly femoral component is used.3-5 Emilios et al.6 showed that patella resurfacing significantly reduced the risk of reoperation and anterior knee pain after TKA. Kordelle et al.7 found out that the patients with patella resurfacing had better functional results. Berti et al.8 demonstrated better clinical scores in kinematic and kinetic data while ascending the stairs. Bourne et al.4 concluded that patella resurfacing seems reasonable in most total knee replacements.
Campbell et al.9 and Burnett et al.10 found no significant functionally and clinically difference between the two groups of patients. They did not recommend routine patella resurfacing.
Matsuda et al.11 observed a mild anterior knee pain in approximately 10% of the cases with un-resurfaced patella.
Calvisi et al.12 suggested that patellar resurfacing would reduce the risk of anterior knee pain as well as the risk of patella related reoperation. Hurson et al.13 found no significant complications. The most conflicting study is from the University of Western Australia14 showed that patients who underwent patellar resurfacing had superior clinical results in term of anterior knee pain and stair descent. In another different study, they with a new design of femoral component (profix) did not notice any advantage for TKA with patellar resurfacing in comparison to absence of resurfacing with respect to any of the measured outcomes.3
As the bulk of evidences and experiences are in the favor of patellar resurfacing, we have revised our practice and started to resurface the patella as indicated. Patellar resurfacing only added a few minutes to the time of surgery and provided less concern for future complains of anterior knee pain. The results of long-term randomized controlled trials can improve the understanding of this complex issue in the future.
Conflict of interest: None declared.
- Garcia RM, Kraay MJ, Goldberg VM. Isolated Resurfacing of the Previously Unresurfaced Patella Total Knee Arthroplasty. Arthroplasty J 16 July 2009. [doi:10.1016/j.arth.2009.06.010]
- Dennis DA. The role of patellar resurfacing in TKA. Point Orthopedics 2006;29:832-835. 
- 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;90:43-9.  [doi:10.1302/0301-620X.90B1.18986]
- Bourne RB, Burnett RS. The consequences of not resurfacing the patella. Clin Orthop Relat Res 2004;(428):166-9.  [doi:10.1097/01.blo.0000147137.05927.bf]
- Whiteside LA. Patella resurfacing no longer considered routine in TKA. Counterpoint Orthopedics 2006;29:833-835. 
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- Kordelle J, Schleicher I, Kaltschmidt I, Haas H, Grüner MR. Patella resurfacing in patients without substantial retropatellar knee pain symptoms? Z Orthop Ihre Grenzgeb 2003;141:557-62. 
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- 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;88:734-9.  [doi:10.1302/0301-620X.88B6.16822]
- 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.  [doi:10.1097/01.blo.0000148594.05443.a3]
- Matsuda S, Ishinishi T, White SE, Whiteside LA. Patellofemoral joint after total knee arthroplasty. Effect on contact area and contact stress. J Arthroplasty 1997;12:790-7.  [doi:10.1016/S0883-5403(97)90010-3]
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- Hurson C, Kashir A, Flavin R, Kelly I. Routine patellar resurfacing using an inset patellar technique. Int Orthop (SICOT) 7 July 2009. [doi:10.1007/s00264-009-0831-0]
- 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:187-93.