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Patella resurfacing provides no advantage at 5 years

A British orthopaedist found no difference between resurfaced, nonresurfaced groups.

Issue: Issue 3 2009

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A recent study of 1,715 total knee replacement patients revealed that the choice to undergo patella resurfacing makes little if any impact on functional outcome at the 5-year mark.

The study, based on the a randomized, controlled, multicenter trial involving 116 surgeons in 34 British centers that began in 1999, is one of the largest to compare scores involving resurfaced patellae with nonresurfaced patellae throughout the United Kingdom.

“We need to know which device or option is most appropriate for which patient, and in particular, should patients have patella resurfacings at the time of knee replacement?” according to David W. Murray, FRCS, of Oxford, England.

Findings show no impact

The primary outcome measures for the study were the Oxford Knee Score (OKS), SF-12, EQ-5D and the need for further surgery. According to Murray, the mean OKS in both the patella resurfacing and nonresurfacing groups was 35 on a scale of 0 to 48 after 5 years. Furthermore, there was no difference in either the SF-12 or EQ-5D scores.

Murray said although there were delayed patella resurfacings in the nonresurfaced group, overall there were no differences in complication rates, reoperation rates or revision rates between the two groups.

The analysis was repeated after subdividing the implants, and he reported that he still could not find anything that would influence the outcome, including whether the implant was domed or anatomic.

“We subdivided them according to whether the manufacturers deemed them to be patella-friendly or not, which really meant, was the patella button, domed or was it anatomic? Even that made absolutely no difference, which just amazed me. It’s staggering,” he said.

“No significant difference”

The lack of variation in scores, Murray said, is a strong indication that the impact patella resurfacing has on the function of a TKR patient at the 5-year mark is negligible at best.

“We see no significant difference in any score,” Murray said. “If there was a difference, it was too small to detect by this study. It would be too small to be of any clinical significance.”

For more information:

• David W. Murray, FRCS, can be reached at Nuffield Orthopaedic Centre, Windmill Road, Headington Oxford, Oxfordshire OX3 7LD, England; +44-(0)1-865-741155; e-mail: david.murray@noc.anglox.nhs.uk. He has no direct financial interest in any company or product mentioned in this article.

Reference:

• Murray DW. Patella resurfacing: 5-year results of a large randomized, controlled trial. Presented at the American Academy of Orthopaedic Surgeons 76th Annual Meeting. Feb. 25-28, 2009. Las Vegas.