Patellar Resurfacing versus Nonresurfacing with Patellaplasty in Total Knee Arthroplasty

Abstract

Background: Anterior knee pain following total knee arthroplasty (TKA) remains one of the important reasons for patient dissatisfaction. The management of patellofemoral joint is controversial and a decision whether to resurface the patella or not, is important. The present study compares the clinical and radiological outcomes between patellar resurfacing and nonresurfacing in patients undergoing bilateral TKA.

Materials and methods: This is a prospective comparative study with 60 patients undergoing bilateral simultaneous TKA (120 knees) with posterior stabilized Hi flex fixed bearing knee (Zimmer, Warsaw, Indiana), by two surgeons. The patients were allocated to the two groups of resurfacing versus nonresurfacing of patella. In nonresurfacing group, patellaplasty was done. Patients with clinicoradiological signs of tricompartmental arthritis were included in the study. Exclusion criteria included unilateral TKA, rheumatoid arthritis, postseptic arthritis, previous high tibial osteotomy, or unicondylar knee arthroplasty cases. Patients were assessed using Knee Society Score (KSS), Modified Samsung Medical Centre Score (MSMCS), Feller patellar score. Radiological evaluation was performed at 1 year using congruence angle and patellar tilt angle.

Results: Mean followup was 19 months (range 12-25 months). Mean KSS, MSMCS, Feller patellar scores in resurfacing group were 82.67, 10.68, and 25.97, respectively and in nonresurfacing group were 82.93, 10.48, and 24.90, respectively. Mean congruence angle in resurfacing group was -12.83° and in nonresurfacing group was -12.383° (P = 0.917) and mean patellar tilt angle in resurfacing is 8.07 and nonresurfacing group is 7.97 (P = 0.873).

Conclusion: There was no statistically significant difference in short-term clinical, functional, and radiological outcomes in the two groups and therefore, routine patellar resurfacing for patient undergoing TKA is not advantageous.

Keywords: Arthroplasty; Feller patellar score; Knee Society Score; knee; patella; patellar dislocation; patellar resurfacing; patellofemoral pain syndrome; replacement; total knee arthroplasty.