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Similar results seen in TKA patients with resurfaced vs. native patellae at 4 years
Researcher cites short-term follow-up and small comparison groups as limitations of the study.
While surgeons have debated the need for patellar resurfacing in total knee arthroplasty, research now indicates no significant differences in the clinical and subjective outcomes of patients who underwent patellar resurfacing compared to those who did not.
In a retrospective study, David DeJour, MD, and colleagues followed two matched cohorts of 94 patients who had total knee arthroplasty (TKA) using the HLS Noetos (Tornier) prosthesis. One group had patellar resurfacing during the TKA, while the control group did not.
A review of 85% of the patients undergoing resurfacing and 80% of the control group revealed no significant differences regarding patient satisfaction, International Knee Society (IKS) revision scores and clinical anterior knee pain scores at 4-year follow-up.
The investigators also found no significant differences between the groups in patellar scores which used the Visual Analog Scale (VAS) to assess femoropatellar pain. In addition, an analysis of the knee score and the patellar index revealed a correlation between patella baja and lower knee scores in the control group.
Indications
“There is not too big of a difference between the two series,” DeJour told Orthopaedics Today Europe. “We can also see that in the other literature. What we found in our study is that we can nearly determine who we can propose to resurface and who we can propose not to resurface.
[Not] resurfacing it’s a good option if the bone is not good quality, as with osteoporosis, and if the patient is young. We know that if we do surgery on a young patient we will probably have to do a revision in 20 years and the problem for total knee revision arthroplasty is mostly the patella. If we keep the patella, it will be easier to do the total knee revision.”
He added that resurfacing is a good option for obese patients, those with patella baja and those at-risk for anterior knee pain.
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These axial views show a patient with a native patella (on the left) and a patient who underwent patellar resurfacing (on the right). Image: DeJour D |
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Complications
The investigators found that 91% of the control group reported that they were satisfied or very satisfied with their procedure compared to 96% of resurfaced patients. In addition, three patients in the control group said that they were considering further surgery for severe anterior knee pain compared to one patient in the resurfaced group. A patellar score based on a 10-point VAS showed a score of 2.19 for the control group and 1.81 for the resurfaced cohort.
Two patients in the control group had stiffness that required mobilization compared to one patient in the resurfaced group. Four patients in the control group underwent a secondary resurfacing for anterior knee pain. In the resurfaced group, one patient had clunk syndrome and underwent an arthroscopic resection. Three other patients in the group had patellar fractures and one patient had a fragment resection.
DeJour cited the short follow-up and small study size as limitations, and noted that nearly 200 patients would be needed in each group to adequately power the study.
For more information:
- David DeJour, MD, can be reached at Corolyon-Sauvegarde, 8 Ave. Ben Gourion, 69009 Lyon, France; +33-472-20-28-20; e-mail: corolyon@wanadoo.fr. He receives royalties from Tornier.
Reference:
- Bonin N, Mercado J, Deschamps G, DeJour D. Resurfacing versus not resurfacing the patella in total knee arthroplasty: 4 year results. Presented at the 13th ESSKA 2000 Congress. May 21-24, 2008. Porto, Portugal.