Selective patella resurfacing strategy for TKA may mitigate ‘catastrophic’ revision scenarios
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ORLANDO — The key to a well-functioning patellofemoral articulation most likely is not whether the patella is resurfaced, but the appropriateness of the surgical technique and implant selected for a given patient, according to a presenter at the Current Concepts in Joint Replacement Winter Meeting, here.
Keith R. Berend , MD , said surgeons who seek definitive guidance from small studies and registry data regarding whether to resurface the patella during primary total knee arthroplasty must realize those resources “don’t paint the entire picture.”
For example, during his presentation, Berend discussed well-known studies of resurfaced and unresurfaced patellae, many of which found identical results with the two techniques.
He said in one widely quoted, randomized controlled trial, “the resurfaced and the non-resurfaced had a nearly identical reoperation rate of approximately 10%.”
Berend said, “The bottom line is just resurfacing the patella doesn’t mean you’re not going to have to revise that knee at some point for something else or, unfortunately, revise the kneecap itself.”
The nature of the surgery to revise a resurfaced patella goes beyond simply going back in and resurfacing the knee cap a second time, he said, noting the surgeon stands a chance of encountering a destroyed or dislocated patella or a ruptured patellar tendon.
“These are revisions that I would put to you are almost catastrophic,” Berend said.
Therefore, he said, selective resurfacing that uses a standardized algorithm “may be a better option than resurfacing everyone and submit them to potentially catastrophic revision scenarios.” – by Susan M. Rapp
Reference:
Berend KR. Paper 88. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 11-14, 2019; Orlando.
Disclosure: Berend reports he receives intellectual property royalties from, is a paid consultant for and receives research support from Zimmer Biomet.