The patella in total knee arthroplasty: to resurface or not is the question

Abstract

The decision to resurface the patella during total knee arthroplasty remains controversial. Even though some surgeons routinely resurface the patella to avoid the increased rates of postoperative anterior knee pain and reoperation for secondary resurfacing, others selectively resurface based on the presence of anterior knee pain, notably damaged articular cartilage, inflammatory arthritis, isolated patellofemoral arthritis, and patellar subluxation and maltracking. The anatomy and biomechanics of the patellofemoral joint, combined with advances in surgical technique and prostheses must be taken into account when making a decision to resurface the patella. Accurate component implantation is imperative for a successful outcome if the patella is resurfaced.

Fig. 1

Intraoperative photograph depicting the lead author’s preferred technique for resecting the eroded patellar bone by going from the medial facet to the lateral facet, keeping the saw blade parallel to the anterior surface of the patella. The goal is for the saw blade to exit the junction of the patella and quadriceps tendon proximally, patella and patellar tendon distally, and articular cartilage and subchondral bone laterally. The patella is then divided into quadrants and each quadrant is measured with a caliper to ensure equal thickness, with a target of 14 mm in most cases