Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Jun 1;105-B(6):622-634.
doi: 10.1302/0301-620X.105B6.BJJ-2022-0970.R2.

Patellar resurfacing versus retention in cruciate-retaining and posterior-stabilized total knee arthroplasty

Cameron J R W Simpson  1 , Evan Wright  1 , Nathan Ng  2 , Ngee J Yap  2 , Solomon Ndou  2 , Chloe E H Scott  2   3 , Nick D Clement  2   3
Affiliations
Meta-Analysis

Patellar resurfacing versus retention in cruciate-retaining and posterior-stabilized total knee arthroplasty

Cameron J R W Simpson et al. Bone Joint J. .

Abstract

Aims: This systematic review and meta-analysis aimed to compare the influence of patellar resurfacing following cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA) on the incidence of anterior knee pain, knee-specific patient-reported outcome measures, complication rates, and reoperation rates.

Methods: A systematic review of MEDLINE, PubMed, and Google Scholar was performed to identify randomized controlled trials (RCTs) according to search criteria. Search terms used included: arthroplasty, replacement, knee (Mesh), TKA, prosthesis, patella, patellar resurfacing, and patellar retaining. RCTs that compared patellar resurfacing versus unresurfaced in primary TKA were included for further analysis. Studies were evaluated using the Scottish Intercollegiate Guidelines Network assessment tool for quality and minimization of bias. Data were synthesized and meta-analysis performed.

Results: There were 4,135 TKAs (2,068 resurfaced and 2,027 unresurfaced) identified in 35 separate cohorts from 33 peer-reviewed studies. Anterior knee pain rates were significantly higher in unresurfaced knees overall (odds ratio (OR) 1.84; 95% confidence interval (CI) 1.20 to 2.83; p = 0.006) but more specifically associated with CR implants (OR 1.95; 95% CI 1.0 to 3.52; p = 0.030). There was a significantly better Knee Society function score (mean difference (MD) -1.98; 95% CI -1.1 to -2.84; p < 0.001) and Oxford Knee Score (MD -2.24; 95% CI -0.07 to -4.41; p = 0.040) for PS implants when patellar resurfacing was performed, but these differences did not exceed the minimal clinically important difference for these scores. There were no significant differences in complication rates or infection rates according to implant design. There was an overall significantly higher reoperation rate for unresurfaced TKA (OR 1.46 (95% CI 1.04 to 2.06); p = 0.030) but there was no difference between PS or CR TKA.

Conclusion: Patellar resurfacing, when performed with CR implants, resulted in lower rates of anterior knee pain and, when used with a PS implant, yielded better knee-specific functional outcomes. Patellar resurfacing was associated with a lower risk of reoperation overall, but implant type did not influence this.

PubMed Disclaimer

Conflict of interest statement

C. E. H. Scott reports consulting fees from Stryker and Smith & Nephew, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Depuy Synthes, and participation on a data safety monitoring board or advisory board with Pfizer, all of which are unrelated to this study. N. D. Clement and C. E. H. Scott are both members of the editorial board of The Bone & Joint Journal.

Similar articles

See all similar articles

Cited by

References

    1. Parsons T , Al-Jabri T , Clement ND , Maffulli N , Kader DF . Patella resurfacing during total knee arthroplasty is cost-effective and has lower re-operation rates compared to non-resurfacing . J Orthop Surg Res . 2021 ; 16 ( 1 ): 185 . 10.1186/s13018-021-02295-8 , 33706779
    1. Matharu G , Blom A , Venkatesh R , Metcalfe A , Whitehouse M . Patellar resurfacing practices in primary total knee replacement: A survey of BASK members . The Knee . 2021 ; 28 : A3 – A5 . 10.1016/j.knee.2020.11.014
    1. No authors listed . The American Joint Replacement Registry Annual Report . American Joint Replacement Registry . 2022 . https://www.aaos.org/registries/publications/ajrr-annual-report/ ( date last accessed 18 April 2023 ).
    1. Robertsson O , W-Dahl A , Lidgren L , Sundberg M , on behalf of the Swedish Knee Arthroplasty Register . Annual Report 2020 . Swedish Knee Arthroplasty Register . 2020 . www.researchgate.net/publication/345602419_The_Swedish_Knee_Arthroplasty... ( date last accessed 28 March 2023 ).
    1. No authors listed . Characteristics of surgical practice for patients undergoing primary knee replacement . National Joint Registry . 2021 . https://reports.njrcentre.org.uk/kneesprimary-procedures-surgical-techni... ( date last accessed 29 March 2023 ).