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Surgeon preference for selective vs routine patellar resurfacing linked with greater revision risk
Compared with surgeons who prefer to routinely resurface the patella, results of this study indicated that surgeons who prefer selective patellar resurfacing were linked with a greater risk of patellar revision and surgeons who infrequently resurfaced the patella had the highest revision risk among groups.
“While the advantages and disadvantages of patella resurfacing in [total knee replacement] TKR have been debated for decades, the decision to resurface or not typically remains the preference of the surgeon,” Christopher J. Vertullo, MBBS, PhD, FRACS(Orth), told Healio.com/Orthopedics. “Selective resurfacing, where the surgeon decides to resurface based on the patient’s individual circumstances to maximize their outcome, is the most popular option internationally.”
He added, “Surgeons with the greater preference for resurfacing had a lower risk of subsequent patellar revision, with a routine patella resurfacing reference having the lowest rate of subsequent revision and later patella resurfacing.”
Vertullo and colleagues used data from the Australian Orthopaedic Association National Joint Replacement Registry to identify 136,116 TKR procedures. Procedures were grouped based on surgeons’ patellar resurfacing preferences, which were categorized as infrequently, selectively or routinely.
Results showed surgeons who selectively resurfaced had a greater risk of patellar revision vs. surgeons who routinely resurfaced the patella. Investigators noticed the risk was greatest in the first 4.5 years postoperatively, with it being 306% higher at 1.5 years postoperatively and 50% higher after 4.5 years postoperatively. The all-cause revision risk was 20% higher in surgeons who selectively resurfaced the patella compared with surgeons who routinely resurfaced the patella.
Surgeons who infrequently resurfaced the patella had the highest revision risk, up to 482% in the first 1.5 years postoperatively vs. those who routinely resurfaced the patella. – by Monica Jaramillo
Disclosures: The authors report no relevant financial disclosures.
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In this article by Vertullo, et al published in the Journal of Bone and Joint Surgery the authors looked at 136,116 cruciate retaining total knee replacements performed in patients with osteoarthritis from the Australian registry and analyzed the risk of patellar revision between surgeons who almost always resurface, sometimes resurface and almost never resurface the patella. They found that revision rates were substantially (336%) higher when surgeons selectively resurface the patella in patients under 65 years of age during their first 3 years post-op. What this study shows is that experienced knee arthroplasty surgeons are not able to accurately identify patients who will be satisfied with an un-resurfaced patella. My interpretation of this paper is to always resurface the patella and save your patients from another potential surgery.
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