Patellar resurfacing in total knee arthroplasty: a prospective, randomized trial.
BACKGROUND
The management of the patella in total knee arthroplasty is still problematic. We aimed to identify differences in the clinical outcome of total knee arthroplasty according to whether or not patellar resurfacing had been performed in a prospective, randomized study of 220 osteoarthritic knees.


METHODS
Two hundred and twenty total knee arthroplasties in 201 patients were randomly assigned to be performed with either resurfacing or retention of the patella, and the results were followed for a mean of forty-eight months (range, thirty-six to seventy-nine months) in a double-blind (both patient and clinical evaluator blinded), prospective study. Evaluation was performed annually by an independent observer and consisted of assessment with the Knee Society clinical rating system, specific evaluation of anterior knee pain, a stair-climbing test, and radiographic examination.


RESULTS
Fifteen (12%) of the 128 knees without patellar resurfacing and nine (10%) of the ninety-two knees with patellar resurfacing underwent a revision or another type of reoperation related to the patellofemoral articulation. This difference was not significant (chi square with one degree of freedom = 0.206, p = 0.650). At the time of the latest follow-up, there was a significantly higher incidence of anterior pain (chi square with one degree of freedom = 5.757, p = 0.016) in the knees that had not had patellar resurfacing.


CONCLUSIONS
Patients who underwent patellar resurfacing had superior clinical results in terms of anterior knee pain and stair descent. However, anterior knee pain still occurred in patients with patellar resurfacing, and nine (10%) of the ninety-two patients in that group underwent a revision or another type of reoperation involving the patellofemoral joint. Weight but not body mass index was associated with the development of anterior knee pain in the patients without patellar resurfacing, a finding that suggests that patellofemoral dysfunction may be a function of joint loading rather than obesity.
Wood
David J
DJ
Division of Orthopaedics, Department of Surgery, University of Western Australia, Nedlands, Western Australia, Australia.
Smith
Anne J
AJ
Collopy
Dermot
D
White
Bruce
B
Brankov
Boris
B
Bulsara
Max K
MK
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007717:Knee; D008297:Male; D010003:Osteoarthritis / Q000601:surgery; D010146:Pain / Q000209:etiology; D010329:Patella / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome