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. 2023 Dec 5;58(1):30-39.
doi: 10.1007/s43465-023-01039-6. eCollection 2024 Jan.

When to Do Selective Patellar Resurfacing in Total Knee Arthroplasty: A Decision-Making Algorithm Based on Pre-operative and Intra-operative Findings

Yuvarajan Palanisamy  1 , Surya Prakash Naidu  1 , Arjun R Prasad  1 , Sugumar Natarajan  1 , David V Rajan  1
Affiliations

When to Do Selective Patellar Resurfacing in Total Knee Arthroplasty: A Decision-Making Algorithm Based on Pre-operative and Intra-operative Findings

Yuvarajan Palanisamy et al. Indian J Orthop. .

Abstract

Background: Persistent anterior knee pain post total knee arthroplasty (TKA) is a significant cause of patient dissatisfaction. Selective patellar resurfacing is commonly practiced for primary total knee replacement (TKR) but there is a paucity in literature regarding its decision making.

Study objective: This study aims to develop a decision-making algorithm for selective patellar resurfacing using Hospital for Special Surgery Patello-femoral Assessment score (HSS PFA score), weight-bearing patellofemoral X-ray, and intraoperative cartilage wear assessment based on the Outerbridge classification.

Materials and methods: This prospective study enrolled 65 patients, assessing preoperative factors including HSS PFA score and Baldini view radiography. Intraoperative cartilage wear was categorized using the Outerbridge classification. Preoperative findings were correlated with intraoperative outcomes through statistical analysis, leading to the development of a predictive algorithm. The efficiency of algorithm was assessed at 3-year follow-up using HSS PFA score.

Results: A significant negative correlation (r = - 0.272, p = 0.029) was observed between HSS PFA score and cartilage wear. However, no significant relationships were established between HSS PFA score and Baldini view observations, including radiological tilt (p = 0.517) and displacement (p = 0.277). Intraoperative cartilage wear versus patellar tilt (p = 0.65) and displacement (p = 0.837) also yielded non-significant results. Three-year follow-up examinations revealed no complications and significant HSS PFA score improvements in all patients.

Conclusion: The requirement for patellar resurfacing can be predicted using a combination of preoperative parameter such as HSS PFA score and the intra-operative cartilage wear. We put forward an algorithm based on above findings to aid in the decision making.

Keywords: Baldini view; HSS patella femoral score; Selective patellar resurfacing.

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Conflict of interest statement

Conflict of interestOn behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
A demonstration of patient positioning for the weight bearing axial view radiograph
Fig. 2
Fig. 2
Patella displacement assessment in a weight bearing modified Merchant view using Radiant dicom viewer
Fig. 3
Fig. 3
Patella displacement assessment in a weight bearing modified merchant view using Radiant dicom viewer
Fig. 4
Fig. 4
The patella is divided into four quadrants (Superomedial, Inferomedial, Superolateral and inferolateral) to assess pattern of wear
Fig. 5
Fig. 5
Clinical photos showing Patella resurfacing technique. a Patella cut using guide, b cut revised using free hand technique with saw to get desired thickness in all quadrants, c three peg holes and multiple drill holes inserted, d trial patella component in situ, e pressurisation during cementation f cemented patellar component in situ
Fig. 6
Fig. 6
Technique of Patelloplasty
Fig. 7
Fig. 7
ROC curve to predict selective patellar resurfacing based on HSS patella score
Fig. 8
Fig. 8
Box plot showing the HSS PFA score of both group of patients
None
Algorithm for selective patellar resurfacing
See this image and copyright information in PMC

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