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Maniar AR, MacDonald SJ. Secondary Patellar Resurfacing Following Primary Unresurfaced Total Knee Arthroplasty: Beware of the Incidence of Late Patellar Erosion. J Arthroplasty 2024:S0883-5403(24)00334-6. [PMID: 38621428 DOI: 10.1016/j.arth.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The primary aim of this study was to evaluate secondary patellar resurfacing (SPR) indications and rates in a single-surgeon series utilizing a modern TKA design and additionally, to review the functional outcomes of patients after undergoing SPR. METHODS A retrospective review of a prospectively collected institutional database was performed. All patients undergoing primary TKA by a single surgeon between 2013 and 2021 were included. During this time, the senior surgeon resurfaced the patella selectively. Patients were divided into the primary resurfaced (PR) and the primary unresurfaced (UR). All patients undergoing SPR in the UR group were identified, their radiographs reviewed, and their clinical outcomes assessed. During the study period, 1,511 TKAs were performed, with 73.1% (1,105 TKAs) being unresurfaced. RESULTS The all-cause revision rate was 1.2% in the PR group and 3.6% in the UR group. The rate of SPR in the UR group was 2.0% (22 of 1,105 TKAs). No patient in the PR group underwent revision surgery for a patellar complication. The mean age at primary TKA for those undergoing SPR was 65 years (range, 50 to 78). The average time for SPR from primary TKA was 3.4 years (range, 1.1 to 8.8). Postoperative radiographic progression of patellar erosion, in combination with new onset anterior knee pain, was the indication for SPR in 14 of the 22 (63.7%) SPR cases. After SPR, the Western Ontario and McMaster University Osteoarthritis Index score (P < .001) and Knee Society Score (P < .001) improved from pre-SPR. CONCLUSIONS Secondary patellar resurfacing (SPR) was the most common (55%) reason for revision surgery after primary UR TKA in this series. An SPR improved clinical outcomes in symptomatic patients. Surgeons should consider patellar resurfacing for all patients undergoing primary TKA to reduce the burden of revision surgery post-TKA. Additionally, the paradigm that late SPR does not improve clinical outcomes needs to be revisited.
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Affiliation(s)
- Adit R Maniar
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Steven J MacDonald
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
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Andronic O, Suravaram V, Lu V, Wall SJ, Bucher TA, Prosser GH, Yates PJ, Jones CW. What are the Outcomes of Secondary Patella Resurfacing for Dissatisfaction Following Primary Knee Arthroplasty? A Systematic Review and Meta-Analysis of 604 Knees. J Arthroplasty 2024; 39:1093-1107.e1. [PMID: 37871862 DOI: 10.1016/j.arth.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Secondary patella resurfacing is often performed for dissatisfaction following primary knee arthroplasty where the native patella was retained. The purpose of this meta-analysis was to evaluate outcomes of secondary patella resurfacing. METHODS The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting on patients who underwent secondary patella resurfacing after previous primary knee arthroplasty with retention of the native patella were considered eligible. The risk of bias was assessed using the Methodological Index for Non-Randomized studies tool. A random-effects model and the inverse-variance weighting method was used for meta-analysis. There were sixteen retrospective studies including 604 knees (594 patients) with a mean follow up of 42 months (range, 2 to 197). RESULTS An overall improvement in patient-reported outcomes (PROMs) was achieved in 53% of cases from pooled data available for 293 knees [95% Confidence Interval (CI) (0.44, 0.62), I2=68% - moderate heterogeneity]. The pooled proportion of patients satisfied with the procedure was 59% [95% CI (48, 68), I2 = 70% - moderate heterogeneity] in a sample size of 415. There was a minimal rate (2%) of complication incidence when performing secondary patella resurfacing and a pooled rate of revision surgery of 10%. CONCLUSIONS An improvement in pain, satisfaction, and PROMs was achieved in slightly more than half of the patients following secondary patella resurfacing. However, studies lacked standardized objective selection criteria for the procedure and the available data was predominantly retrospective, with high heterogeneity and variation in outcome reporting.
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Affiliation(s)
- Octavian Andronic
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia; Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Vishwa Suravaram
- Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Simon J Wall
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Thomas A Bucher
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Gareth H Prosser
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Piers J Yates
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Christopher W Jones
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia; Curtin University, Perth, Australia
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Gunderson ZJ, Luster TG, Deckard ER, Meneghini RM. The Fate of Unresurfaced Patellae in Contemporary Total Knee Arthroplasty: Early to Midterm Results. J Arthroplasty 2024:S0883-5403(24)00082-2. [PMID: 38336307 DOI: 10.1016/j.arth.2024.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Leaving the patella unresurfaced in total knee arthroplasty (TKA) has increased significantly over the past decade in the United States, likely due to modern patella-friendly implants, complications with resurfacing, and the knowledge that historical studies were scientifically confounded. This study evaluated revision-free survivorship out to 8.5 years in a cohort of contemporary primary TKAs with patella-friendly femoral components and unresurfaced patellae. METHODS A total of 1,053 consecutive primary TKAs with unresurfaced patellae were retrospectively reviewed. A selective patellar nonresurfacing protocol was used for all cases. Kaplan-Meier survivorship estimates were calculated based on patellar revision and the latest follow-up. An aggressive lateral patellar facetectomy was performed in 78% (823 of 1,053) of cases. The cohort was 62% women and 43% American Society of Anesthesiologists physical status classification I or II with a mean age and body mass index of 65 years (range, 35 to 94) and 35 kg/m2 (range, 18 to 65), respectively. RESULTS A total of 4 (0.4%, 4 of 1,053) unresurfaced patellae were revised. Three were resurfaced as part of other procedures: 2 for global instability and one for aseptic loosening at a mean of 1.6 years; and one patella was resurfaced by an outside surgeon for unexplained pain. The all-cause revision-free survivorship estimate specifically related to the patella was 98.9% (95% confidence interval, 98 to 100) out to 8.5 years. No significant difference in survivorship was related to patellae with or without a lateral patellar facetectomy (99.5 versus 98.1%, P ≥ .191); however, 3 of 4 patellar revisions occurred in TKAs without a lateral patellar facetectomy (P = .035). CONCLUSIONS The results of this study demonstrate excellent revision-free survivorship related to unresurfaced patellae, particularly when a lateral facetectomy was performed. These early to midterm results using modern patella-friendly femoral components are promising and comparable to resurfaced patellae in the literature. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Zachary J Gunderson
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Taylor G Luster
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana Joint Replacement Institute, Indianapolis, Indiana
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Pardo F, Giardina F, Ancarani C, Bordini B, Castagnini F, Perdisa F, Traina F. Higher failure rate of secondary patellar resurfacing following bicompartmental knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:6315-6321. [PMID: 37261480 DOI: 10.1007/s00402-023-04924-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION The role of secondary patellar resurfacing (SPR) in anterior knee pain (AKP) is still debated in literature. A regional arthroplasty registry was investigated, aiming to: (1) assess the survival rate of SPR; and (2) compare SPR to tricompartmental TKA. MATERIALS AND METHODS The regional arthroplasty registry RIPO was investigated about all SPRs performed after bicompartmental arthroplasty. The survival rates and the reasons for revision were assessed as any other factor that could have influenced implants failure. SPR survivorship was compared to tricompartmental TKAs. RESULTS 406 SPRs performed after bicompartmental arthroplasty were analyzed. The survival rates were 80.6% (CI 95% 75.9-84.5) at 5 years and 77.6% (CI 95% 72.4-82) at 7 years. Half of the SPRs was performed 0.9-2.4 years after the index bicompartmental arthroplasty. SPR achieved lower survival than tricompartmental TKA (80.6% vs 96.7%, p < 0.001), with an adjusted hazard ratio for failure of 5.5 (CI 95% 4.2-7.1, p < 0.001). SPRs performed within 2 years after primary implant had a significantly higher rates of failure when compared to tricompartmental TKA (HR: 6.4, CI 95% 4.8-8.4, p < 0.001). CONCLUSION SPR after bicompartmental knee arthroplasty showed modest 5- and 7-year survival rates, worse than primary tricompartmental TKA. When SPRs are performed within 2 years after primary arthroplasty, a significant higher risk of failure should be expected, highlighting than appropriate pre-operative work-up and patient selection is crucial for SPR successful outcome. LEVEL OF EVIDENCE III, therapeutic study.
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Affiliation(s)
- Francesco Pardo
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Federico Giardina
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Cristina Ancarani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | | | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
- Orthopaedics and Traumatology, DIBINEM, University of Bologna, Bologna, Italy
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Schmidt GJ, Farooq H, Deckard ER, Meneghini RM. Selective Patella Resurfacing in Contemporary Cruciate Retaining and Substituting Total Knee Arthroplasty: A Matched Cohort Analysis. J Arthroplasty 2023; 38:491-496. [PMID: 36252746 DOI: 10.1016/j.arth.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Leaving the patella unresurfaced in total knee arthroplasty (TKA) is increasing due to modern patella-friendly implants, awareness that complications are not uncommon with resurfacing, and knowledge that historical studies were scientifically confounded. This study examined the effect of selective patellar resurfacing on patient-reported outcome measures (PROMs) using modern implants and techniques in cohorts rigorously matched for demographics and osteoarthritis severity. METHODS A total of 166 TKAs performed without patellar resurfacing were case-control matched to 166 TKAs with patella resurfacing. Case-control matching was based on demographics, American Society of Anesthesiology Physical Status, comorbidities, and osteoarthritis severity. No significant differences were observed between cohorts for demographics (P ≥ .347), comorbidities (P ≥ .443), or radiographic osteoarthritis severity (P ≥ .078). Radiographic alignment and prospectively collected PROMs were evaluated preoperatively and at latest clinical follow-up. RESULTS Preoperatively, patellar tilt was less for the unresurfaced patella group (3 versus 4°, P = .003); however, postoperative patellar tilt was not different (3 versus 3°, P = .225). At a mean of 2.1 years follow-up (range, 1 to 7), University of California Los Angeles Activity Level was significantly higher for the unresurfaced patella group (6.3 versus 5.5, P = .002), but the mean group difference did not reach a minimal clinically important difference. There were no other significant differences in PROMs or reoperation rates between cohorts (P ≥ .135). CONCLUSION In contemporary cruciate retaining and substituting TKA designs, not resurfacing the patella in select patients may achieve comparable PROMs and re-operation rates; and potentially greater activity level compared to patella resurfacing at early follow-up. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Gregory J Schmidt
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Hassan Farooq
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana Joint Replacement Institute, Indianapolis, Indiana
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Noh JH, Kim NY, Song KI. Comparison of clinical outcomes between patellar resurfacing and patellar non-resurfacing in cruciate retaining total knee arthroplasty. J Orthop Surg (Hong Kong) 2022; 30:10225536221092223. [PMID: 35392729 DOI: 10.1177/10225536221092223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is not established whether patellar resurfacing is better than patellar non-resurfacing during total knee arthroplasty (TKA). This study was to compare the clinical outcomes between groups with patellar resurfacing and non-resurfacing during cruciate retaining (CR) TKA. METHODS In this retrospective cohort study, subjects undergoing primary CR TKA for osteoarthritis between 2012 and 2019 were included. Of 500 subjects, 250 had patellar resurfacing (group 1) and 250 had patellar non-resurfacing (group 2) CR TKA. Knee society knee score (KSKS), knee society function score (KSFS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scale, Kujala score, anterior knee pain, patellar compression test and range of motion (ROM) of the replaced knee were assessed and compared between the two groups. RESULTS There were no significant differences in KSKS, KSFS, WOMAC scale, Kujala score, prevalence of anterior knee pain and ROM of the replaced knee between the two groups at the last follow-up (p > .05). Group 2 had more subjects with positive patellar compression test than group 1 at the last follow-up (p = .010). CONCLUSIONS Clinical and functional outcomes of the replaced knee were not different between patellar resurfacing and non-resurfacing groups. Anterior knee pain was significantly reduced after total knee arthroplasty regardless of patellar resurfacing. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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Affiliation(s)
- Jung Ho Noh
- Department of Orthopaedic Surgery, 70518Kangwon National University Hospital, Chuncheon-si, South Korea
| | - Nam Yeop Kim
- Department of Orthopaedic Surgery, 70518Kangwon National University Hospital, Chuncheon-si, South Korea
| | - Ki Ill Song
- Department of Orthopaedic Surgery, 70518Kangwon National University Hospital, Chuncheon-si, South Korea
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Osteoarthritic Severity in Unresurfaced Patellae Does Not Adversely Affect Patient-reported Outcomes in Contemporary Primary TKA. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202204000-00008. [PMID: 35389915 PMCID: PMC8989776 DOI: 10.5435/jaaosglobal-d-22-00041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 11/18/2022]
Abstract
Introduction: The degree of osteoarthritis (OA) acceptable to leave in a native patella during unresurfaced total knee arthroplasty (TKA) remains unknown. This study's purpose was to examine the effect of patellofemoral OA severity on patient-reported outcome measures (PROMs) in primary TKAs performed without patellar resurfacing. Methods: One hundred ninety-three primary TKAs performed without patellar resurfacing were retrospectively reviewed. Preoperative patellofemoral OA severity was graded on severity, marginal osteophytes, joint space narrowing, and chondral damage using accepted grading systems. Patellar tilt and tibiofemoral alignment were measured radiographically. PROMs were evaluated at a minimum of 1-year follow-up. Results: In multivariate regression, preoperative lateral patella Kellgren-Lawrence grade ≥2 was associated with superior change in Knee Society Score pain with level walking, higher absolute change in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (P ≤ 0.029), and knees ‟always feeling normal” (odds ratio [OR] 3.12; P = 0.005). Osteoarthritis Research Society International atlas grades and Outerbridge classification scores did not significantly influence PROMs. Discussion: Worse preoperative OA severity in the lateral patellar facet, graded with the Kellgren-Lawrence system, predicted superior knee-specific PROMs in patients with unresurfaced patellae after contemporary TKA. This observation supports the clinical finding that patients with more severe OA have optimized patient outcomes and highlights the minimal contribution of patella OA to knee function after primary TKA.
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Held MB, Gazgalis A, Sarpong NO, Geller JA, Shah RP, Cooper HJ. Management of the Patella During Total Knee Arthroplasty. JBJS Rev 2021; 9:01874474-202109000-00011. [PMID: 34516451 DOI: 10.2106/jbjs.rvw.21.00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The optimal management of the patella during total knee arthroplasty (TKA) remains a controversial topic with no consensus. » Patellar management techniques during TKA include patellar retention or resurfacing with or without patellaplasty, as well as circumferential denervation and partial lateral facetectomy (PLF). » Special considerations such as patient age, etiology of disease, implant design, and surgeon preference should be accounted for when determining optimal management. » We recommend that most patellae be circumferentially denervated, regardless of whether they are resurfaced, as the potential benefits outweigh the small associated risks. » Evidence demonstrates improved functional outcomes with the addition of PLF to nonresurfaced patellae. There is currently a paucity of evidence of this technique with respect to resurfaced patellae. » Patellar resurfacing adds additional costs and health-care resources that should be considered in the decision-making process.
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Affiliation(s)
- Michael B Held
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
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Huish EG, Coury JG, Ummel JR, Deans JT, Cohen J, Casey JJ. Higher rate of kneeling after primary knee arthroplasty without patellar resurfacing at midterm review. J Orthop 2020; 20:204-206. [PMID: 32025150 PMCID: PMC6997512 DOI: 10.1016/j.jor.2019.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/03/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | - Jason R. Ummel
- Valley Orthopedic Surgery Residency, Doctors Medical Center, 1400 Florida Ave. Ste 201, Modesto, CA, 95350, USA
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Long-Term Comparison Study of Patella Resurfacing Versus Non-resurfacing in Total Knee Arthroplasty with Minimum 10-Year Follow-Up. Indian J Orthop 2020; 54:631-638. [PMID: 32850027 PMCID: PMC7429564 DOI: 10.1007/s43465-020-00165-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/01/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Management of the patella during total knee arthroplasty is a matter of constant debate. Numerous studies have assessed and compared the mechanical and clinical results of total knee arthroplasty with native as well as resurfaced patellae. However, the consensus has not been reached yet on this subject. This study aims to compare the outcome between patella resurfaced (PR) and non-resurfaced patellae (NPR) after a follow-up of minimum 10 years following total knee arthroplasty. MATERIALS AND METHODS This is a retrospective study including 63 subjects (103 knees) who had undergone total knee arthroplasty with a follow-up of 10-14 years. In this study, we evaluated the knees implanted with either press fit condylar (PFC) sigma (Depuy, Johnson & Johnson) or Nexgen (CR flex/LPS flex) (Zimmer, Warsaw, Indiana, USA) implants. Whether to perform patella resurfacing or not and choice of implants as well as implant design (posterior stabilized/cruciate retaining) was surgeons' preference. At final follow-up, clinical and functional outcome was assessed using Knee Society Scores (KSS), and comparison of difference between pre-op scores and scores at final follow-up among resurfaced versus non-resurfaced patellae groups was carried out. Patello-femoral function was assessed at final follow-up using Feller's score and the results were compared between resurfaced and non-resurfaced patellae. RESULTS The mean follow-up was 140 months (range 124-168 months). There were 62 knees with their patella resurfaced and 41 knees with non-resurfaced patellae There was no significant difference in the mean pre-op Knee Society Scores between PR (46.29 ± 5.17) and NPR (47.34 ± 5.95), p value 0.34. Similarly there was no significant difference in their pre-op functional score as well PR (38.53 ± 5.14) and NPR (39.22 ± 6.79), p value 0.56. Both groups had significantly improved post-operative Knee Society Scores PR (85.95 ± 5.23) and NPR (84.65 ± 5.30). However, there is no difference between these groups, p value 0.22. Functional scores also maintained significant improvement at final follow-up. Between the two groups, the resurfaced group showed a significantly higher functional score at final follow-up: PR (70.90 ± 7.73) and NPR (66.44 ± 7.12), p value 0.02. Feller's score at final follow-up for PR group was (23.36) and NPR group was (21.98), p value 0.001, which showed clear superiority of PR over NPR. CONCLUSION After a minimum follow-up of 10 years, there were no differences in clinical results; however, the knee function score and patello-femoral function scoring was found to be significantly higher with patella resurfacing and it was persistent across all the subgroups we had included in the study-posterior stabilized/cruciate retaining or between implants made by two different manufacturers.
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Coory JA, Tan KG, Whitehouse SL, Hatton A, Graves SE, Crawford RW. The Outcome of Total Knee Arthroplasty With and Without Patellar Resurfacing up to 17 Years: A Report From the Australian Orthopaedic Association National Joint Replacement Registry. J Arthroplasty 2020; 35:132-138. [PMID: 31477541 DOI: 10.1016/j.arth.2019.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/12/2019] [Accepted: 08/02/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patellar resurfacing in total knee arthroplasty (TKA) remains a controversial issue after more than 4 decades of TKA. Despite a growing body of evidence from registry data, resurfacing is still based largely on a surgeon's preference and training. The purpose of this study is to provide long-term outcomes for patellar resurfaced compared to when the patella is not resurfaced. METHODS Data from the Australian Orthopaedic Association National Joint Replacement Registry (1999-2017) were used for this study. The analysis included 570,735 primary TKAs undertaken for osteoarthritis. Hazard ratios (HRs) and 17-year cumulative percent revision rates were used to compare revision rates between 4 subgroups: minimally stabilized (MS) patellar resurfacing, posterior stabilized (PS) patellar resurfacing, MS unresurfaced, and PS unresurfaced patella. Additional analyses of the patellar implant type and a comparison of inlay and onlay patellar resurfacing were also performed. RESULTS For all primary TKA, procedures where the patella was not resurfaced have a higher rate of revision compared to procedures where the patella was resurfaced (HR, 1.31; confidence interval, 1.28-1.35; P < .001). Unresurfaced PS knees have the highest cumulative percent revision at 17 years (11.1%), followed by MS unresurfaced (8.8%), PS resurfaced (7.9%), and MS resurfaced (7.1%). Inlay patellar resurfacing has a higher rate of revision compared to onlay patellar resurfacing (HR, 1.27; confidence interval, 1.17-1.37; P < .001). CONCLUSION Resurfacing the patella reduces the rate of revision for both MS and PS knees. MS knees with patellar resurfacing have the lowest rate of revision. Onlay patella designs are associated with a lower revision rate compared to inlay patella designs.
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Affiliation(s)
- Joseph A Coory
- Department of Orthopaedic Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Kelvin G Tan
- Orthopaedic Research Unit, Queensland University of Technology (QUT), Brisbane, Australia
| | - Sarah L Whitehouse
- Orthopaedic Research Unit, Queensland University of Technology (QUT), Brisbane, Australia
| | - Alesha Hatton
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, Australia
| | - Ross W Crawford
- Orthopaedic Research Unit, Queensland University of Technology (QUT), Brisbane, Australia
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Use of technetium bone scans to help predict whether patellar resurfacing will be successful in treating pain after primary total knee arthroplasty. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Maney AJ, Koh CK, Frampton CM, Young SW. Usually, Selectively, or Rarely Resurfacing the Patella During Primary Total Knee Arthroplasty: Determining the Best Strategy. J Bone Joint Surg Am 2019; 101:412-420. [PMID: 30845035 DOI: 10.2106/jbjs.18.00389] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgeons may "usually" resurface the patella during total knee arthroplasty (TKA), "rarely" resurface, or "selectively" resurface on the basis of certain criteria. It is unknown which of these 3 strategies yields superior outcomes. Utilizing New Zealand Joint Registry data, we investigated (1) what proportion of surgeons employs each of the 3 patellar resurfacing strategies, (2) which strategy is associated with the lowest overall revision rate, and (3) which strategy is associated with the highest 6-month and 5-year Oxford Knee Score (OKS). METHODS Two hundred and three surgeons who performed a total of 57,766 primary TKAs from 1999 to 2015 were categorized into the 3 surgeon strategies on the basis of how often they resurfaced the patella during primary total knee arthroplasty; with "rarely" defined as <10% of the time, "selectively" as ≥10% to ≤90%, and "usually" as >90%. For each strategy, the cumulative incidence of all-cause revision was calculated and utilized to construct Kaplan-Meier survival curves. The mean 6-month and 5-year postoperative OKS for each group were utilized for comparison. RESULTS Overall, 57% of surgeons selectively resurfaced, 37% rarely resurfaced, and 7% usually resurfaced. The usually resurfacing group was associated with the highest mean OKS at both 6 months (38.57; p < 0.001) and 5 years postoperatively (41.34; p = 0.029), followed by the selectively resurfacing group (6-month OKS, 37.79; 5-year OKS, 40.87) and the rarely resurfacing group (6-month OKS, 36.92; 5-year OKS, 40.02). Overall, there was no difference in the revision rate per 100 component years among the rarely (0.46), selectively (0.52), or usually (0.46) resurfacing groups (p = 0.587). Posterior-stabilized TKAs that were performed by surgeons who selectively resurfaced had a lower revision rate (0.54) than those by surgeons who usually resurfaced (0.64) or rarely resurfaced (0.74; p < 0.001). CONCLUSIONS Usually resurfacing the patella was associated with improved patient-reported outcomes, but there was no difference in overall revision rates among the 3 strategies. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Chuan K Koh
- Department of Orthopaedic Surgery, Southland Hospital, Invercargill, New Zealand
| | | | - Simon W Young
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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Agarwala S, Shetty V, Karumuri LK, Vijayvargiya M. Patellar Resurfacing versus Nonresurfacing with Patellaplasty in Total Knee Arthroplasty. Indian J Orthop 2018; 52:393-398. [PMID: 30078898 PMCID: PMC6055458 DOI: 10.4103/ortho.ijortho_512_16] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anterior knee pain following total knee arthroplasty (TKA) remains one of the important reasons for patient dissatisfaction. The management of patellofemoral joint is controversial and a decision whether to resurface the patella or not, is important. The present study compares the clinical and radiological outcomes between patellar resurfacing and nonresurfacing in patients undergoing bilateral TKA. MATERIALS AND METHODS This is a prospective comparative study with 60 patients undergoing bilateral simultaneous TKA (120 knees) with posterior stabilized Hi flex fixed bearing knee (Zimmer, Warsaw, Indiana), by two surgeons. The patients were allocated to the two groups of resurfacing versus nonresurfacing of patella. In nonresurfacing group, patellaplasty was done. Patients with clinicoradiological signs of tricompartmental arthritis were included in the study. Exclusion criteria included unilateral TKA, rheumatoid arthritis, postseptic arthritis, previous high tibial osteotomy, or unicondylar knee arthroplasty cases. Patients were assessed using Knee Society Score (KSS), Modified Samsung Medical Centre Score (MSMCS), Feller patellar score. Radiological evaluation was performed at 1 year using congruence angle and patellar tilt angle. RESULTS Mean followup was 19 months (range 12-25 months). Mean KSS, MSMCS, Feller patellar scores in resurfacing group were 82.67, 10.68, and 25.97, respectively and in nonresurfacing group were 82.93, 10.48, and 24.90, respectively. Mean congruence angle in resurfacing group was -12.83° and in nonresurfacing group was -12.383° (P = 0.917) and mean patellar tilt angle in resurfacing is 8.07 and nonresurfacing group is 7.97 (P = 0.873). CONCLUSION There was no statistically significant difference in short-term clinical, functional, and radiological outcomes in the two groups and therefore, routine patellar resurfacing for patient undergoing TKA is not advantageous.
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Affiliation(s)
- Sanjay Agarwala
- Department of Orthopaedics, P.D. Hinduja National Hospital, Mumbai, Maharashtra, India
| | - Vivek Shetty
- P.D. Hinduja National Hospital, Mumbai, Maharashtra, India
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Thomas C, Patel V, Mallick E, Esler C, Ashford RU. The outcome of secondary resurfacing of the patella following total knee arthroplasty: Results from the Trent and Wales Arthroplasty Register. Knee 2018; 25:146-152. [PMID: 29366665 DOI: 10.1016/j.knee.2017.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 09/18/2017] [Accepted: 10/10/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND We sought to determine whether patients undergoing secondary patella resurfacing (SPR) benefited from the procedure by assessing postoperative satisfaction via a postal questionnaire. METHODS All such patients included in the Trent and Wales Arthroplasty Register were invited to participate using patient-reported outcome measures (PROMs). We identified 223 patients who had undergone SPR over a 20-year period. Forty-two had died according to death register checks. Eighty-eight of 181 (48.6%) questionnaires were completed. The mean age at resurfacing was 67 (min. 42, max. 81); 52% were female. The median time to follow-up was 55months (interquartile range (IQR) 41-111). Median time to SPR was 28months (IQR 20-42). RESULTS Thirty-nine patients (44%) felt that SPR resolved the problem of pain in the front of their knee. All PROMs were significantly better for those who felt that the resurfacing had worked (Oxford Knee Score 29 vs. 16, P<0.05, modified Kujala 51 vs. 32, P<0.05, EQ5D-3L 0.616 vs. 0.384, P<0.05). Based on PROMs, SPR produces a satisfactory outcome in two of every five patients. CONCLUSIONS Surgeons must be clear on the cause of anterior knee pain post-total knee replacement, and patients must be made aware of what outcomes can be reasonably expected from this procedure.
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Moghtadaei M, Sajadi MRM, Farahini H, Yeganeh A. Osteophytes removal in patella versus lateral facetectomy of the patella in patella-retaining total knee arthroplasty. Interv Med Appl Sci 2017; 9:15-19. [PMID: 28932491 PMCID: PMC5598117 DOI: 10.1556/1646.9.2017.1.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In this study, the results of the partial lateral facetectomy of the patella to better patellofemoral motion and congruence are compared with the results of the osteophyte removal of the patella and neurectomy only in total knee arthroplasty (TKA). METHODS Data from 55 patients undergoing TKA with osteophytes removal of the patella and neurectomy only, and those undergoing osteophytes removal of the patella and neurectomy and partial lateral facetectomy were reviewed retrospectively. Clinical outcomes were evaluated by knee society score (KSS) and functional score of knee. Clinical anterior knee pain (AKP) rating and knee range of motion and extension lag were assessed for each patient. RESULTS There was significant difference between two groups in AKP (p < 0.05), and the mean range of motion of the knee in groups 1 and 2 was 117° ± 9° and 116.6° ± 8.2°, respectively. Three (13%) patients of the reshaped patella group and three (11%) patients of the non-reshaped patella group had extension lag <10°, respectively. The mean KSS and knee functional scores showed no statistical difference between groups (p > 0.05). CONCLUSION Partial lateral facetectomy of the patella can decrease AKP and can be used routinely for every patient that surgeon does not decide to resurface the patella.
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Affiliation(s)
- Mehdi Moghtadaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran, Iran and Department of Orthopedics, Rasoul-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Mohammad Reza Miniator Sajadi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran, Iran and Department of Orthopedics, Rasoul-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Hossein Farahini
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran, Iran and Department of Orthopedics, Rasoul-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Ali Yeganeh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran, Iran and Department of Orthopedics, Rasoul-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
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Cerciello S, Robin J, Lustig S, Maccauro G, Heyse TJ, Neyret P. The role of patelloplasty in total knee arthroplasty. Arch Orthop Trauma Surg 2016; 136:1607-1613. [PMID: 27687176 DOI: 10.1007/s00402-016-2577-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Anterior knee pain (AKP) is a frequent complication after total knee arthroplasty (TKA). Patelloplasty, defined as reshaping the patella for optimal tracking in the trochlea, has been proposed to reduce the rate of this complication in patellar retaining implants. Aim of this study was to analyze the available literature regarding the outcomes of patelloplasty and to assess its methodological quality. MATERIALS AND METHODS A comprehensive review of the English literature was performed using the keywords "total knee arthroplasty", "patelloplasty" and "patellaplasty" with no limit regarding the year of publication. All the selected articles were evaluated with the Coleman score. RESULTS Seven full text articles were retrieved. The initial cohort included 461 knees in the study groups and 465 in the control groups. At an average FU of 70.6 months 447 knees were reviewed in the study group and 447 in the control groups. The global rate of AKP after patelloplasty was 11.3 % which compared to 7.9 % in the patella resurfacing control group. No signs of specific patellar complications due to patelloplasty were reported. Average Coleman score was 66.9. CONCLUSION Most of the literature has barely sufficient methodological quality. Patelloplasty aims at reducing patellar thickness and improve its tracking with TKA. This procedure is a safe and easy option with no reported adverse effects. In the included studies, outcome seemed to be superior in comparison with isolated osteophyte removal and denervation with a lower rate of AKP. The included studies, however, report a lower rate of AKP following TKA with patellar resurfacing. Patelloplasty may have the potential to improve the outcome of patellar retaining implants. LEVEL OF EVIDENCE 4, systematic review.
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Affiliation(s)
- Simone Cerciello
- Casa di Cura Villa Betania, Via Piccolomini 27, 00165, Rome, Italy. .,Marrelli Hospital, Via Gioacchino da Fiore, 0962, Crotone, Italy.
| | - Jonathan Robin
- Albert Trillat Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Sébastien Lustig
- Albert Trillat Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Giulio Maccauro
- Department of Geriatric Neurosciences and Orthopaedics, Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Thomas J Heyse
- Center for Orthopaedics and Trauma Surgery, University Hospital, Baldingerstrasse, 35043, Marburg, Germany
| | - Philippe Neyret
- Albert Trillat Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
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van Jonbergen HPW, Boeddha AV, M van Raaij JJA. Patient Satisfaction and Functional Outcomes Following Secondary Patellar Resurfacing. Orthopedics 2016; 39:e850-6. [PMID: 27172365 DOI: 10.3928/01477447-20160509-05] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 03/28/2016] [Indexed: 02/03/2023]
Abstract
When secondary patellar resurfacing is performed, a uniformly and widely used scoring system that is validated for anterior knee pain caused by a retropatellar degeneration will give more insight into the results of this procedure. The cause of anterior knee pain following total knee arthroplasty (TKA) is not always related to the patella itself. Other causes have been identified, such as an insufficient posterior cruciate ligament in the case of a posterior cruciate-retaining TKA or an internally rotated femoral and/or tibial component. Treatment of anterior knee pain following primary TKA with secondary patellar resurfacing is a controversial procedure with uncertain outcomes. The purpose of this study is to systematically review the available peer-reviewed literature on patient satisfaction and functional outcomes of secondary resurfacing. The authors performed a systematic computerized database search of the Cochrane Database of Systematic Reviews, MEDLINE, and EMBASE in October 2014. The quality of the included studies was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. A total of 15 articles met the inclusion criteria. In total, 148 (64%) of 232 patients were satisfied with the outcomes of secondary patellar resurfacing. A statistically significant improvement in knee scores was noted in all 9 studies that reported functional outcomes, although no clinically significant improvement in knee scores was observed. Reported complications include infections and impaired wound healing, patellar instability, and patellar fracture. Because the available evidence is of generally low quality, the results of this systematic review only support a weak recommendation for secondary patellar resurfacing if patient satisfaction and clinically important improvement of functional outcomes are the desired endpoints. [Orthopedics.2016; 39(5):e850-e856.].
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Toro-Ibarguen AN, Navarro-Arribas R, Pretell-Mazzini J, Prada-Cañizares AC, Jara-Sánchez F. Secondary Patellar Resurfacing as a Rescue Procedure for Persistent Anterior Knee Pain After Primary Total Knee Arthroplasty: Do Our Patients Really Improve? J Arthroplasty 2016; 31:1539-43. [PMID: 27038861 DOI: 10.1016/j.arth.2016.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/08/2015] [Accepted: 01/04/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Secondary patellar resurfacing (SPR) is a procedure that can be used in patients with persistent anterior knee pain (AKP) after a primary total knee arthroplasty. The aim of our study was to analyze the clinical and functional outcomes as well as the complications of this procedure and identify predictive factors for a favorable outcome. METHODS Forty-six patients who underwent SPR for persistent AKP after primary total knee arthroplasty were retrospectively studied. The patient's mean age was 68 years (range, 36-86 years). The average follow-up time after SPR was 74 months (range, 24-197 months). Demographic data, Knee Society Score scale, range of motion, pain improvement (Visual Analogue Scale), overall satisfaction, and complications were recorded. The statistical analysis was performed using STATA tm/SE v10. RESULTS There was an improvement of the Knee Society scale (from 54 ± 11 to 64 ± 16 points; P < .05). However, in 59% of the cases, there was no pain improvement, and 65% of patients were not satisfied. Four patients showed complications, and in 2 cases, reoperation was necessary. We did not find any preoperative predictive factor for a favorable outcome after SPR. CONCLUSION Despite improvement of the Knee Society scale, many patients continue with AKP and are dissatisfied with this procedure; therefore, we do not recommend it in this clinical scenario.
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Affiliation(s)
| | | | - Juan Pretell-Mazzini
- Muskuloskeletal Oncology Division, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Fernando Jara-Sánchez
- Arthroplasty Division, Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain
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Beswick AD, Wylde V, Gooberman-Hill R. Interventions for the prediction and management of chronic postsurgical pain after total knee replacement: systematic review of randomised controlled trials. BMJ Open 2015; 5:e007387. [PMID: 25967998 PMCID: PMC4431062 DOI: 10.1136/bmjopen-2014-007387] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Total knee replacement can be a successful operation for pain relief. However, 10-34% of patients experience chronic postsurgical pain. Our aim was to synthesise evidence on the effectiveness of applying predictive models to guide preventive treatment, and for interventions in the management of chronic pain after total knee replacement. SETTING We conducted a systematic review of randomised controlled trials using appropriate search strategies in the Cochrane Library, MEDLINE and EMBASE from inception to October 2014. No language restrictions were applied. PARTICIPANTS Adult patients receiving total knee replacement. INTERVENTIONS Predictive models to guide treatment for prevention of chronic pain. Interventions for management of chronic pain. PRIMARY AND SECONDARY OUTCOME MEASURES Reporting of specific outcomes was not an eligibility criterion but we sought outcomes relating to pain severity. RESULTS No studies evaluated the effectiveness of predictive models in guiding treatment and improving outcomes after total knee replacement. One study evaluated an intervention for the management of chronic pain. The trial evaluated the use of a botulinum toxin A injection with antinociceptive and anticholinergic activity in 49 patients with chronic postsurgical pain after knee replacement. A single injection provided meaningful pain relief for about 40 days and the authors acknowledged the need for a large trial with repeated injections. No trials of multidisciplinary interventions or individualised treatments were identified. CONCLUSIONS Our systematic review highlights a lack of evidence about the effectiveness of prediction and management strategies for chronic postsurgical pain after total knee replacement. As a large number of people are affected by chronic pain after total knee replacement, development of an evidence base about care for these patients should be a research priority.
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Affiliation(s)
- Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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Roberts DW, Hayes TD, Tate CT, Lesko JP. Selective patellar resurfacing in total knee arthroplasty: a prospective, randomized, double-blind study. J Arthroplasty 2015; 30:216-22. [PMID: 25316378 DOI: 10.1016/j.arth.2014.09.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/13/2014] [Accepted: 09/16/2014] [Indexed: 02/01/2023] Open
Abstract
350 knees were evaluated in a prospective, randomized, double-blinded study of selective patellar resurfacing in primary total knee arthroplasty. Knees with exposed bone on the patellar articular surface were excluded. 327 knees were evaluated at a mean follow-up of 7.8years. 114 knees followed for greater than 10 years were analyzed separately. Satisfaction was higher in patients with a resurfaced patella. In patients followed for at least 10 years, no significant difference was found. No difference was found in KSS scores or survivorship. No complications of patellar resurfacing were identified. The vast majority of patients with remaining patellar articular cartilage do very well with total knee arthroplasty regardless of patellar resurfacing. Patient satisfaction may be slightly higher with patellar resurfacing.
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Affiliation(s)
| | - T David Hayes
- Northwest Surgical Research Foundation, Vancouver, Washington
| | - Christine T Tate
- Department of Physical Therapy, Southwest Washington Medical Center, Vancouver, Washington
| | - James P Lesko
- Biostatistics and Outcomes Research, DePuy Orthopaedics, Warsaw, Indiana
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Pagenstert G, Seelhoff J, Henninger HB, Wirtz DC, Valderrabano V, Barg A. Lateral patellar facetectomy and medial reefing in patients with lateral facet syndrome after patellar-retaining total knee arthroplasty. J Arthroplasty 2014; 29:2156-62. [PMID: 25070901 DOI: 10.1016/j.arth.2014.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/13/2014] [Accepted: 06/24/2014] [Indexed: 02/01/2023] Open
Abstract
We analyzed clinical outcomes of partial lateral patellar facetectomy and medial reefing in patients with lateral patellar facet syndrome with painful patellar-retaining total knee arthroplasty. 34 patients were followed for a mean of 40 months. All 34 patients were matched with those having secondary patellar resurfacing without facetectomy. Both groups experienced significant pain relief and range of motion improvement. The facetectomy group had higher Kujala scores than those in patellar resurfacing group. Patients with facetectomy had significantly less pain postoperatively. There were significant differences in postoperative lateral patellar tilt and congruency angle in both groups. The mid-term results for LPF with medial reefing are promising to resolve pain in patients with lateral patellar facet syndrome in patellar-retaining TKA. Therapeutic level III (retrospective comparative study).
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Affiliation(s)
- Geert Pagenstert
- Department of Orthopaedic Surgery, University Hospital of Basel, Basel, Switzerland
| | | | - Heath B Henninger
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT
| | - Dieter C Wirtz
- Department of Orthopaedic Surgery, University Hospital, Friedrich-Wilhelms-University of Bonn, Bonn, Germany
| | - Victor Valderrabano
- Department of Orthopaedic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Alexej Barg
- Department of Orthopaedic Surgery, University Hospital of Basel, Basel, Switzerland
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Bischoff MJFJ, van Raaij TM, Reininga IHF, van Raay JJAM. Patellar resurfacing in posterior cruciate ligament retaining total knee arthroplasty (PATRES): design of a randomized controlled clinical trial. BMC Musculoskelet Disord 2014; 15:358. [PMID: 25351573 PMCID: PMC4232658 DOI: 10.1186/1471-2474-15-358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 10/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anterior knee pain may occur after total knee arthroplasty (TKA). Patellar resurfacing, which is considered to lower the incidence of anterior knee pain after TKA, remains controversial. In the present study clinical and radiological outcomes after TKA performed on patients with clinical and radiological signs of femorotibial and patellofemoral osteoarthritis (OA) with and without patellar resurfacing will be compared. METHODS/DESIGN Fifty patients will be included in a randomized controlled trial. Patients scheduled for TKA with clinical and radiological signs of femorotibial and patellofemoral OA will be included. Arthritis of the patellofemoral joint was determined based on the preoperative Baldini and Merchant X-ray views, which is assessed by the orthopaedic surgeon who treats the patient. Exclusion criteria are rheumatoid arthritis, history of patellar fracture, tuberosity transposition, high tibial osteotomy (HTO), hip arthroplasty and posterior cruciate ligament insufficiency. Patients will be randomized to undergo TKA either with or without patellar resurfacing. Outcomes will be assessed preoperatively, at 6 weeks and at 6, 12, 18 and 24 months postoperatively. Primary outcome measure is the patellofemoral scoring system according to Baldini. Secondary outcome measures are the Knee Society clinical rating system (KSS) and the Knee Osteoarthritis Outcome Scale (KOOS) scores. Conventional weight-bearing radiographs, and views according to Baldini will be used to asses component loosening, wear, and patellofemoral problems including fracture or loosening of resurfaced patellae, subluxation and wear of non-resurfaced patellae. DISCUSSION There is no consensus regarding patellar resurfacing during primary TKA. Current prospective studies fail to determine any differences in clinical outcome among patients after TKA with or without patellar resurfacing. This randomized controlled trial has been designed to determine the effectiveness of patellar resurfacing during TKA in patients undergoing TKA who have clinical and radiological signs of tibiofemoral and patellofemoral OA, using a specific patellofemoral outcome measurement. TRIAL REGISTRATION Netherlands Trial Registry NTR3108.
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Affiliation(s)
| | - Tom M van Raaij
- Department of Orthopaedic Surgery, Martini Hospital Groningen, Van Swietenplein 1, 9728, NT Groningen, The Netherlands.
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Schiavone Panni A, Cerciello S, Del Regno C, Felici A, Vasso M. Patellar resurfacing complications in total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2014; 38:313-7. [PMID: 24363045 PMCID: PMC3923924 DOI: 10.1007/s00264-013-2244-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 12/01/2013] [Indexed: 01/14/2023]
Abstract
PURPOSE The ideal management of the patella during total knee arthroplasty (TKA) is still controversial. Patellar retention is generally associated with an increased rate of anterior knee pain; however, patient satisfaction is similar in cases of replacement or retention. When the patella is replaced, potential severe complications can occur. Aim of this study was to retrospectively review results of a continuous series of patients having been treated with TKA and patella resurfacing. METHODS The charts of 1,600 consecutive total knee prostheses were analysed to evaluate the rate of patellar resurfacing. All implants were posterior stabilized; 310 patients having received a patellar replacement were reviewed at follow-up (FU) examination. Complete physical examination as well as administration of the Hospital for Special Surgery (HSS) score was performed. X-rays analysis included weightbearing anteroposterior (AP) and lateral views of the injured knee and bilateral skyline views at 30° flexion. RESULTS Two hundred and eighty patients were available for clinical and imaging investigation at an average FU of 96 (58-144) months. Mean age at the time of surgery was 70 (62-80) years. Mean HSS score was 85.9 ± 7.6. The overall rate of patellofemoral complications was 7% (19 cases); 13 patients claimed anterior knee pain, five had symptomatic patellar maltracking and one had patellar component loosening. CONCLUSION Our data are in accordance with those available in the literature. Recent meta-analyses demonstrated lower risk of re-operation after patellar resurfacing. However, when complications of the resurfaced patella occur, they can be potentially catastrophic events.
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Affiliation(s)
- Alfredo Schiavone Panni
- Department of Medicine, Orthopaedic Clinic, Molise University, Via de Sanctis 1, 00168 Campobasso, Italy
| | - Simone Cerciello
- Department of Medicine, Orthopaedic Clinic, Molise University, Via de Sanctis 1, 00168 Campobasso, Italy
| | - Chiara Del Regno
- Department of Medicine, Orthopaedic Clinic, Molise University, Via de Sanctis 1, 00168 Campobasso, Italy
| | - Alessandro Felici
- Department of Medicine, Orthopaedic Clinic, Molise University, Via de Sanctis 1, 00168 Campobasso, Italy
| | - Michele Vasso
- Department of Medicine, Orthopaedic Clinic, Molise University, Via de Sanctis 1, 00168 Campobasso, Italy
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Bhattee G, Moonot P, Govindaswamy R, Pope A, Fiddian N, Harvey A. Does malrotation of components correlate with patient dissatisfaction following secondary patellar resurfacing? Knee 2014; 21:247-51. [PMID: 23332248 DOI: 10.1016/j.knee.2012.12.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 12/11/2012] [Accepted: 12/15/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of our study was to identify whether there was any correlation between the outcome of secondary patellar resurfacing and malrotation of either the femoral or tibial component. METHODS We identified patients that underwent secondary patellar resurfacing following previous primary total knee arthroplasty (TKA) at a single, large orthopaedic department. Patients were reviewed for range of movement, satisfaction, health status and knee function. CT scanning was performed, assessing rotational alignment of the components. RESULTS Twenty-one patients (23 knees) were reviewed. Nine out of 21 (39%) were satisfied while 14 (61%) remained dissatisfied after the secondary patellar resurfacing. There were no complications after the secondary procedure. All knees were internally rotated. The mean femoral internal rotation in the satisfied group was 0.92°, and in the dissatisfied group was 2.88° of internal rotation. In the dissatisfied group eight out of 14 TKAs were in >3° femoral internal rotation compared with only one in nine TKAs in the satisfied group (p<0.05). CONCLUSIONS Investigation for malrotation should be considered in patients with post-operative pain, especially anteriorly, causing significant dissatisfaction amongst patients following TKA. This is especially true if the patella has not been primarily resurfaced and secondary resurfacing is being considered. Patients with more than 3(°) of femoral internal rotation undergoing secondary patella resurfacing should be warned of the possibility of a poor outcome. It may well be that if the underlying problem is component malrotation, revision knee replacement may lead to a more satisfactory outcome than secondary resurfacing alone. LEVEL OF EVIDENCE Level of Evidence III.
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Affiliation(s)
- Ghias Bhattee
- The Royal Bournemouth Hospital, Bournemouth, Dorset, UK.
| | | | | | - Andrew Pope
- The Royal Bournemouth Hospital, Bournemouth, Dorset, UK
| | - Nick Fiddian
- The Royal Bournemouth Hospital, Bournemouth, Dorset, UK
| | - Adrian Harvey
- The Royal Bournemouth Hospital, Bournemouth, Dorset, UK
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Petersen W, Rembitzki IV, Brüggemann GP, Ellermann A, Best R, Koppenburg AG, Liebau C. Anterior knee pain after total knee arthroplasty: a narrative review. INTERNATIONAL ORTHOPAEDICS 2013; 38:319-28. [PMID: 24057656 PMCID: PMC3923935 DOI: 10.1007/s00264-013-2081-4] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 08/11/2013] [Indexed: 12/21/2022]
Abstract
Anterior knee pain is one of the most common causes of persistent problems after implantation of a total knee replacement. It can occur in patients with or without patellar resurfacing. As a result of the surgical procedure itself many changes can occur which may affect the delicate interplay of the joint partners in the patello-femoral joint. Functional causes of anterior knee pain can be distinguished from mechanical causes. The functional causes concern disorders of inter- and intramuscular coordination, which can be attributed to preoperative osteoarthritis. Research about anterior knee pain has shown that not only the thigh muscles but also the hip and trunk stabilising muscles may be responsible for the development of a dynamic valgus malalignment. Dynamic valgus may be a causative factor for patellar maltracking. The mechanical causes of patello-femoral problems after knee replacement can be distinguished according to whether they increase instability in the joint, increase joint pressure or whether they affect the muscular lever arms. These causes include offset errors, oversizing, rotational errors of femoral or tibial component, instability, maltracking and chondrolysis, patella baja and aseptic loosening. In these cases, reoperation or revision is often necessary.
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Affiliation(s)
- Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar Theyß Strasse 27-31, 14193, Berlin Grunewald, Germany,
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The efficacy of patellar decompression for improving anterior knee pain following total knee arthroplasty without patellar resurfacing. Arch Orthop Trauma Surg 2013; 133:561-7. [PMID: 23435648 DOI: 10.1007/s00402-013-1702-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Indexed: 02/09/2023]
Abstract
BACKGROUND Anterior knee pain remains common following total knee arthroplasty (TKA). In this study, we evaluated the efficacy of patellar decompression via drilling for the treatment of anterior knee pain following TKA without patellar resurfacing. METHODS A prospective cohort study was performed in 271 consecutive patients who underwent primary total knee replacement with patellar decompression (study group, n = 131) or without decompression (control group, n = 140). The patients were assessed according to the Knee Society rating, clinical anterior knee pain score, and British Orthopaedic Association patient-satisfaction score in each group. Each assessment was performed without the examiner knowing whether the patella had been decompressed. Radiographic evaluations were also performed according to the Knee Society scoring system for functional activity and our own severity grade system for patellofemoral articular change. RESULTS There were no adverse events following patellar decompression. The overall prevalence of anterior knee pain was not significantly different between groups (p = 0.71). However, patients presenting pain over grade II after the operation in the study group were statistically low (p = 0.01). The overall postoperative knee scores were higher in the study group, but there were no significant differences between groups (p = 0.0731). Analyses of the radiographs revealed similar postoperative outcomes in both groups of knees. CONCLUSIONS As we observed significantly lower rates of anterior knee pain and no patellar complications following patellar decompression via drilling in TKA without patellar resurfacing, we recommend performing patellar decompression in cases of total knee replacement without patellar resurfacing.
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Kumahashi N, Tadenuma T, Kuwata S, Fukuba E, Uchio Y. A longitudinal study of the quantitative evaluation of patella cartilage after total knee replacement by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping at 3.0 T: preliminary results. Osteoarthritis Cartilage 2013; 21:126-35. [PMID: 23099213 DOI: 10.1016/j.joca.2012.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 07/23/2012] [Accepted: 09/18/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To characterize the quantitative changes of patella cartilage over time after total knee arthroplasty (TKA) by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping at 3.0 T. METHOD Twenty-six knees of 26 patients (23 women and three men, mean age, 75 years) with primary osteoarthritis and osteonecrosis of the knee underwent TKA with a zirconia ceramic implant in this prospective study. Twelve patients without patella resurfacing (NR group) and 14 patients with patella resurfacing (R group) had TKA with cemented fixation. The implant position was examined by radiograph, computed tomography (CT) and magnetic resonance imaging (MRI). The clinical scores were checked pre-operatively, 1 year post-operatively and at the final follow-up. Patella cartilage and its thickness were evaluated pre-operatively and 1 year after TKA by dGEMRIC and T2 mapping in the NR group only. Patella cartilage was divided into eight regions of interest: the deep and superficial layers of the outer lateral and medial half, and the inner lateral and medial half from the central ridge. RESULTS The implant position was appropriate in all cases and clinical scores were not significantly different between the two groups. The post-operative dGEMRIC value of the outer medial half superficial zone in the NR group was significantly decreased compared with the pre-operation value (P<0.05), whereas T2 mapping was not significantly changed in all zones. The cartilage thickness of the outer zone was significantly thinner post-operatively (P<0.05). CONCLUSIONS These findings indicate that osteoarthritic changes in the outer zone of patella cartilage occurred 1 year after TKA.
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Affiliation(s)
- N Kumahashi
- Department of Orthopaedics, Shimane University, School of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane 693-8501, Japan.
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Radiologische Diagnostik, Beurteilung und Behandlung des patellofemoralen Schmerzes nach primärer Knieendoprothetik. Radiologe 2012; 52:987-93. [DOI: 10.1007/s00117-012-2410-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Correia J, Sieder M, Kendoff D, Citak M, Gehrke T, Klauser W, Haasper C. Secondary Patellar Resurfacing after Primary Bicondylar Knee Arthroplasty did Not Meet Patients' Expectations. Open Orthop J 2012; 6:414-8. [PMID: 23002412 PMCID: PMC3447165 DOI: 10.2174/1874325001206010414] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 07/25/2012] [Accepted: 08/03/2012] [Indexed: 11/29/2022] Open
Abstract
Secondary patella resurfacing is a controversial procedure which is applied in patients with anterior knee pain
after a bicondylar knee arthroplasty (with unresurfaced patella). A group of 46 patients were submitted to this procedure
and their satisfaction, range of motion and pain improvement was evaluated. 52.2% of the patients were satisfied with the
procedure, with an improvement in pain (Visual Analogue Scale) of 65% and an improvement in range of motion in
56,5%, with roundabout half of the patients having no resolution to their complaints. Whilst an improvement was not
achieved in all patients, as it was initially hypothesised, this procedure should be considered when a revision knee
arthroplasty is performed with an unresurfaced patella.
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Altay MA, Ertürk C, Altay N, Akmeşe R, Işıkan UE. Patellar denervation in total knee arthroplasty without patellar resurfacing: a prospective, randomized controlled study. Orthop Traumatol Surg Res 2012; 98:421-5. [PMID: 22552314 DOI: 10.1016/j.otsr.2012.03.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 02/24/2012] [Accepted: 03/06/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anterior knee pain is still a major problem in total knee arthroplasty (TKA). Although the most widely accepted opinion is that anterior knee pain is often associated with a patellofemoral etiology, there is no clear consensus as to etiology or treatment. Disabling pain receptors by electrocautery could theoretically achieve denervation of the anterior knee region. The present prospective randomized controlled study aimed to evaluate results after patellar denervation with electrocautery in TKA at a minimum follow-up of 2 years. HYPOTHESIS Patellar denervation provides some benefit in terms of pain and clinical outcomes after TKA without patellar resurfacing. PATIENTS AND METHODS Clinical and radiological results for 35 patients with single-stage bilateral TKA (70 knees; 26 women, nine men; mean age, 68 years [range, 58 to 77 years]) were reviewed. In addition to removal of all osteophytes, patellar denervation by electrocautery was performed on one patella; and debridement alone, removing all osteophytes, was performed on the contralateral patella, as a control. KSS score and a visual analog scale (VAS) were used to assess pre- and postoperative anterior knee pain. RESULTS Mean follow-up was 36 months (24 to 60 months). No revisions or re-operations were performed. There were no patellar fractures. On all parameters (KSS score, range of motion and VAS), there was a statistically significant pre- to postoperative difference in favor of the denervation group. DISCUSSION Patellar denervation with electrocautery can reduce anterior knee pain, with satisfactory clinical and radiological outcome, in TKA without patellar resurfacing. LEVEL OF EVIDENCE Level II: low-powered prospective randomized trial.
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Affiliation(s)
- M A Altay
- Department of Orthopaedics and Traumatology, Harran University School of Medicine, Yenisehir, 63100 Sanliurfa, Turkey.
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32
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[The third compartment in knee endoprosthetics: from denervation to replacement, which therapy is correct?]. DER ORTHOPADE 2012; 40:896-8, 900-1. [PMID: 21947572 DOI: 10.1007/s00132-011-1778-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Involvement of the patellofemoral compartment is common in osteoarthritis of the knee but to date there is no consensus as to the most appropriate approach concerning the patella. Both general non-selective resurfacing as well as selective or secondary resurfacing are currently accepted. However, despite abundant studies on the subject no clear conclusions can be drawn from the available evidence. There are arguments in favour of either approach. Accordingly, no strong evidence can be found to support peripatellar denervation. With the advent of new diagnostic modalities for the assessment of knee osteoarthritis, such as single photon emission computed tomography/CT (SPECT/CT), a more selective approach to patellar resurfacing with a potentially improved outcome might become possible.
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Parvizi J, Mortazavi SMJ, Devulapalli C, Hozack WJ, Sharkey PF, Rothman RH. Secondary resurfacing of the patella after primary total knee arthroplasty does the anterior knee pain resolve? J Arthroplasty 2012; 27:21-6. [PMID: 21676581 DOI: 10.1016/j.arth.2011.04.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Accepted: 04/16/2011] [Indexed: 02/01/2023] Open
Abstract
Although it has been shown that the risk of anterior knee pain is greater in patients with nonresurfaced patellae, it is not exactly clear whether the pain would resolve with secondary resurfacing of the patella. Thirty-nine patients (41 knees) underwent secondary patellar resurfacing between January 2001 and January 2007. The mean age was 66 years. The mean body mass index was 29.2 kg/m(2). The average time from primary total knee arthroplasty to resurfacing procedure was 29 months. The mean follow-up was 54 months. Anterior knee pain was the indication for secondary resurfacing in all patients. Although the clinical and functional knee scores improved significantly for whole cohort, 8 patients (8 knees) were dissatisfied with the outcome of surgery. This study highlights that secondary resurfacing is not an always rewarding procedure and patients need to be consulted appropriately with regard to the outcome.
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Affiliation(s)
- Javad Parvizi
- Rothman Institute of Orthopedics at Thomas Jefferson UniversityHospital, Philadelphia, Pennsylvania 19107, USA
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35
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Swan JD, Stoney JD, Lim K, Dowsey MM, Choong PFM. The need for patellar resurfacing in total knee arthroplasty: a literature review. ANZ J Surg 2010; 80:223-33. [PMID: 20575947 DOI: 10.1111/j.1445-2197.2010.05242.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The controversy over whether or not to routinely resurface the patella during a total knee arthroplasty has persisted despite three decades of successful joint replacement procedures. Advocates for routine patellar resurfacing admit the occasional need for secondary patellar resurfacing and declare increased incidence of anterior knee pain in patients with non-resurfaced patellae as a cause for worry. Surgeons that leave the patella unresurfaced cite avoidance of complications that include patellar fracture, avascular necrosis, patellar tendon injury and instability. This review discusses the available literature on patellar resurfacing through an evidence-based analysis of randomized and pseudo-randomized controlled trials and published meta-analyses to date. The published literature seems to favour resurfacing the patellar routinely. Selective patellar resurfacing would be the ideal solution if sound pre-operative criteria could be established. So far, a method for accurately predicting which patients can avoid patellar resurfacing has not been found. Future research looking at patellar resurfacing should concentrate on developing criteria for selecting those patients that would benefit from patellar resurfacing and those that would do as well without resurfacing, and thus, limiting potential surgical complications.
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Affiliation(s)
- John D Swan
- Department of Orthopaedics and University of Melbourne Department of Surgery, St Vincent's Health, Melbourne, Australia
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36
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Gupta S, Augustine A, Horey L, Meek RMD, Hullin MG, Mohammed A. Electrocautery of the patellar rim in primary total knee replacement: beneficial or unnecessary? ACTA ACUST UNITED AC 2010; 92:1259-61. [DOI: 10.1302/0301-620x.92b9.24467] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The management of the patella during total knee replacement is controversial. In some studies the absence of patellar resurfacing results in residual anterior knee pain in over 10% of patients. One form of treatment which may be used in an endeavour to reduce this is circumferential patellar rim electrocautery. This is believed to partially denervate the patella. However, there is no evidence of the efficacy of this procedure, nor do we know if it results in harm. A retrospective comparative cohort study was performed of 192 patients who had undergone a primary total knee replacement with the porous coated Low Contact Stress rotating platform prosthesis without patellar resurfacing between 2003 and 2007. In 98 patients circumferential electrocautery of the patellar rim was performed and in 94 patients it was not. The two groups were matched for gender and age. The general Oxford Knee Score and the more specific patellar score for anterior knee pain were used to assess patient outcomes a minimum of two years post-operatively. No statistically significant differences were noted between the groups for either scoring system (p = 0.41 and p = 0.87, respectively). Electrocautery of the patella rim did not improve the outcome scores after primary total knee replacement in our patients.
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Affiliation(s)
- S. Gupta
- Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - A. Augustine
- Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - L. Horey
- Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - R. M. D. Meek
- Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - M. G. Hullin
- Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - A. Mohammed
- Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
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Garcia RM, Kraay MJ, Goldberg VM. Isolated resurfacing of the previously unresurfaced patella total knee arthroplasty. J Arthroplasty 2010; 25:754-8. [PMID: 19615851 DOI: 10.1016/j.arth.2009.06.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Accepted: 06/07/2009] [Indexed: 02/01/2023] Open
Abstract
Postoperative anterior knee pain can be challenging after primary total knee arthroplasty. Isolated patellar resurfacing may provide symptomatic improvement in those patients with an unresurfaced patella. Seventeen isolated patellar resurfacing procedures were performed. Patient outcomes were evaluated using the Knee Society clinical and roentgenographic evaluation systems. Continued symptomatology and overall patient satisfaction were also analyzed. No revisions have been necessary at 47 months of follow-up. Overall, Knee Society knee scores and knee function scores significantly improved. Eight patients (53%) are asymptomatic and were satisfied with the procedure, whereas 7 patients (47%) continue to have anterior knee pain and are unsatisfied. Isolated patellar resurfacing for anterior knee pain in total knee arthroplasty with an unresurfaced patella has a low morbidity and revision rate but may not provide patients with predictable symptomatic improvement.
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Affiliation(s)
- Ryan M Garcia
- Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio 44106, USA
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Spencer SJ, Young D, Blyth MJG. Secondary resurfacing of the patella in total knee arthroplasty. Knee 2010; 17:187-90. [PMID: 19740664 DOI: 10.1016/j.knee.2009.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 07/31/2009] [Accepted: 08/04/2009] [Indexed: 02/02/2023]
Abstract
Anterior knee pain following primary total knee arthroplasty is common and can be difficult to treat satisfactorily. We reviewed 28 consecutive patients (29 knees) who underwent secondary resurfacing of the patella for persistent anterior knee pain and report on the results. Mean follow-up was 28 months (range 12-61) with no cases lost to follow-up. Oxford knee scores, range of motion, the patient's assessment of outcome and overall satisfaction were recorded. Seventeen out of 19 (59%) felt their knee was better following patellar resurfacing, 10 out of 29 (34%) felt it was the same and two out of 29 (7%) felt it was worse. There was a significant improvement in Oxford knee scores (p<0.001) and significant increase in patient satisfaction (p<0.001) following secondary resurfacing. While secondary resurfacing of the patella does not provide the solution for every case of anterior knee pain following total knee joint replacement, in greater than 50% of cases it can be effective at relieving symptoms and in this series carries a low risk of worsening symptoms or complications.
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Affiliation(s)
- Simon J Spencer
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, 84-106 Castle Street, Glasgow, UK.
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Clements WJ, Miller L, Whitehouse SL, Graves SE, Ryan P, Crawford RW. Early outcomes of patella resurfacing in total knee arthroplasty. Acta Orthop 2010; 81:108-13. [PMID: 19968604 PMCID: PMC2856213 DOI: 10.3109/17453670903413145] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Patella resurfacing in total knee arthroplasty is a contentious issue. The literature suggests that resurfacing of the patella is based on surgeon preference, and little is known about the role and timing of resurfacing and how this affects outcomes. METHODS We analyzed 134,799 total knee arthroplasties using data from the Australian Orthopaedic Association National Joint Replacement Registry. Hazards ratios (HRs) were used to compare rates of early revision between patella resurfacing at the primary procedure (the resurfacing group, R) and primary arthroplasty without resurfacing (no-resurfacing group, NR). We also analyzed the outcomes of NR that were revised for isolated patella addition. RESULTS At 5 years, the R group showed a lower revision rate than the NR group: cumulative per cent revision (CPR) 3.1% and 4.0%, respectively (HR = 0.75, p < 0.001). Revisions for patellofemoral pain were more common in the NR group (17%) than in the R group (1%), and "patella only" revisions were more common in the NR group (29%) than in the R group (6%). Non-resurfaced knees revised for isolated patella addition had a higher revision rate than patella resurfacing at the primary procedure, with a 4-year CPR of 15% and 2.8%, respectively (HR = 4.1, p < 0.001). INTERPRETATION Rates of early revision of primary total knees were higher when the patella was not resurfaced, and suggest that surgeons may be inclined to resurface later if there is patellofemoral pain. However, 15% of non-resurfaced knees revised for patella addition are re-revised by 4 years. Our results suggest an early beneficial outcome for patella resurfacing at primary arthroplasty based on revision rates up to 5 years.
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Affiliation(s)
| | - Lisa Miller
- Data Management and Analysis Centre, Discipline of Public Health, University of Adelaide, Adelaide
| | | | | | - Philip Ryan
- Data Management and Analysis Centre, Discipline of Public Health, University of Adelaide, Adelaide
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Ahmad R, Kumar GS, Katam K, Dunlop D, Pozo JL. Significance of a "hot patella" in total knee replacement without primary patellar resurfacing. Knee 2009; 16:337-40. [PMID: 19254845 DOI: 10.1016/j.knee.2009.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2008] [Revised: 01/31/2009] [Accepted: 02/05/2009] [Indexed: 02/02/2023]
Abstract
A "hot patella" is a bone scan finding of increased tracer uptake in the patella, greater than the ipsilateral distal femur or the proximal tibia. Increased patellar uptake on the bone scans is a relatively frequent finding; this is often not commented upon. The aim of our study was to define the incidence of a "hot patella" on bone scans following total knee replacements with ongoing symptoms unrelated to sepsis. We wanted to investigate the correlation between the adverse retropatellar symptomatology following total knee replacement with bone scan findings. We undertook a retrospective study of 55 symptomatic total knee replacement patients, who had bone scans. The incidence of a "hot patella" in patients without primary patellar resurfacing was 51% (28/55). Ninety-five percent patients with anterior knee pain and 21% patients with diffuse knee pain had a "hot patella". Statistical analysis showed a positive association between "hot patella" and anterior knee pain (p value of <0.001). The patients with "hot patella" who underwent secondary patellar resurfacing had symptomatic relief of symptoms. Our study has shown that the finding of a "hot patella" on a bone scan in patients with anterior knee pain following total knee replacement suggests a problem related to the patellofemoral joint. This study would appear to indicate that a "hot patella" in a patient with clinically defined anterior knee pain is likely to benefit from secondary patellar resurfacing.
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Affiliation(s)
- R Ahmad
- Department of Trauma & Orthopaedics, Frenchay Hospital, Bristol, United Kingdom.
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Almeida RFDC, Queiroz AABD, Belloti JC, Castro Filho JMBD, Cohen M, Navarro RD. Approach towards total knee arthroplasty in Brazil: cross-sectional study. SAO PAULO MED J 2009; 127:190-7. [PMID: 20011923 DOI: 10.1590/s1516-31802009000400003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 08/27/2009] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Total knee arthroplasty (TKA) has evolved particularly since the 1970s, with improvements in implants and surgical instruments, and has thus become an effective intervention for treating knee arthrosis. Many studies have presented rates of satisfactory clinical and radiological results greater than 90%, from follow-ups of over ten years. Nevertheless, despite scientific evidence showing the efficacy of TKA, the approaches taken present controversies in certain respects. The objective of this study was to evaluate how the Brazilian orthopedists deal with TKA, with investigation of the main aspects of this procedure. DESIGN AND SETTING Cross-sectional survey conducted during the 39th Brazilian Congress of Orthopedics and Traumatology, in São Paulo, Brazil, in November 2007. METHODS We applied a questionnaire to orthopedists registered at the congress. The questionnaire was randomly distributed and participation was voluntary; 858 completed questionnaires were included in the analysis. RESULTS Most of the Brazilian orthopedists were members of SBOT and worked in the southeastern region. They used imported cemented implants through an anterior access route centered on the patella, with replacement of the joint surface of the patella and preservation of the posterior cruciate ligament. They did not have experience with simultaneous bilateral TKA. Postoperatively, they used antibiotics and suction drains for 48 hours. There was no consensus regarding prophylaxis for venous thromboembolism or the frequency of the main complications. CONCLUSION The majority of Brazilian orthopedists work in the southeastern region of the country and agree about the main aspects of the approaches towards TKA.
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How to address the patella in revision total knee arthroplasty. Knee 2009; 16:92-7. [PMID: 18819807 DOI: 10.1016/j.knee.2008.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 08/10/2008] [Accepted: 08/16/2008] [Indexed: 02/02/2023]
Abstract
Patellar issues need to be carefully addressed during any revision TKA and the surgeon often faces the question of what to do with the patella at the time of revision. The choice of treatment is often made by balancing what is technically feasible with the risk of potential complications and takes into account the reason for the revision, the type of implant (i.e., metal-backing or all-polyethylene), the duration of implantation, the fixation, the stability, the sterilization technique, the wear, the presence of osteolysis, the compatibility with the femoral component, and most importantly the remaining bone stock. The various treatment options then include retention of the patellar component, revision of the patellar component, removal of the component with retention of the patellar bony shell (patelloplasty or resection arthroplasty), excision of the patella (partial or total patellectomy), secondary resurfacing, and reconstruction/augmentation of the patellar bone stock. Isolated patellar revision is associated with a high complication rate and recurrent failure when poor patellar tracking, incongruent designs and malalignment of the femoral and tibial components exist. Retention of a well-fixed all-PE (non-oxidized) patella is advocated where possible and revision of metal-backed patella is recommended (unless well fixed with poor bone stock). In the situation of a deficient patella, patelloplasty, augmentation procedures and very rarely patellectomy are other viable options.
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Ortiz-Espada A, Pérez-Mañanes R, Corella-Montoya F, Chana-Rodríguez F, Medina-Herráez E, Vaquero-Martín J. Artroplastia patelar secundaria en el tratamiento de la prótesis total de rodilla dolorosa. Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1888-4415(08)75587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ortiz-Espada A, Pérez-Mañanes R, Corella-Montoya F, Chana-Rodríguez F, Medina-Herráez E, Vaquero-Martín J. Secondary patellar resurfacing in painful total knee arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1988-8856(08)70123-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Helmy N, Anglin C, Greidanus NV, Masri BA. To resurface or not to resurface the patella in total knee arthroplasty. Clin Orthop Relat Res 2008; 466:2775-83. [PMID: 18726657 PMCID: PMC2565036 DOI: 10.1007/s11999-008-0420-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Accepted: 07/11/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED The management of the patellar articular surface at the time of primary total knee arthroplasty (TKA) is controversial. We used expected-value decision analysis to determine whether the patella should be resurfaced in TKA, and also whether secondary resurfacing on an unresurfaced patella is worthwhile. Outcome probabilities and utility values were derived from randomized controlled trials only. A decision tree was constructed and fold-back analysis was performed to ascertain the best treatment path. Sensitivity analyses were performed to determine the effect on decision-making of varying outcome probabilities and utilities. Our model showed patellar resurfacing is the best management strategy for the patella at the time of primary TKA. This decision is robust to changes in the specific data: the best path would remain the same as long as the incidence of persistent anterior knee pain (AKP) with resurfacing remains less than 29% (current mean, 12%) or the incidence of AKP after nonresurfacing falls below 12% (current mean, 26%). Delayed (ie, secondary) patellar resurfacing for ongoing patellar pain provides inferior results for the majority of patients. LEVEL OF EVIDENCE Level II, decision analysis. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Naeder Helmy
- Department of Orthopaedics, University of Zurich, Uniklinik Balgrist, Zurich, Switzerland
- Department of Orthopaedics, Vancouver Hospital and Health Sciences Centre, University of British Columbia, 910 West 10th Avenue, Third Floor, Vancouver, BC Canada V5Z 4E1
| | - Carolyn Anglin
- Centre for Bioengineering Research & Education, and Department of Civil Engineering, University of Calgary, Calgary, AB Canada
| | - Nelson V. Greidanus
- Department of Orthopaedics, Vancouver Hospital and Health Sciences Centre, University of British Columbia, 910 West 10th Avenue, Third Floor, Vancouver, BC Canada V5Z 4E1
| | - Bassam A. Masri
- Department of Orthopaedics, Vancouver Hospital and Health Sciences Centre, University of British Columbia, 910 West 10th Avenue, Third Floor, Vancouver, BC Canada V5Z 4E1
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Less anterior knee pain with a mobile-bearing prosthesis compared with a fixed-bearing prosthesis. Clin Orthop Relat Res 2008; 466:1959-65. [PMID: 18523833 PMCID: PMC2584251 DOI: 10.1007/s11999-008-0320-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 05/13/2008] [Indexed: 02/06/2023]
Abstract
UNLABELLED Anterior knee pain is one of the major short-term complaints after TKA. Since the introduction of the mobile-bearing TKA, numerous studies have attempted to confirm the theoretical advantages of a mobile-bearing TKA over a fixed-bearing TKA but most show little or no actual benefits. The concept of self-alignment for the mobile bearing suggests the posterior-stabilized mobile-bearing TKA would provide a lower incidence of anterior knee pain compared with a fixed-bearing TKA. We therefore asked whether the posterior-stabilized mobile-bearing knee would in fact reduce anterior knee pain. We randomized 103 patients scheduled for cemented three-component TKA for osteoarthrosis in a prospective, double-blind clinical trial. With a 1-year followup, more patients experienced persistent anterior knee pain in the posterior-stabilized fixed-bearing group (10 of 53, 18.9%) than in the posterior-stabilized mobile-bearing group (two of 47, 4.3%). No differences were observed for range of motion, visual analog scale for pain, Oxford 12-item questionnaire, SF-36, or the American Knee Society score. The posterior-stabilized mobile-bearing knee therefore seems to provide a short-term advantage compared with the posterior-stabilized fixed-bearing knee. LEVEL OF EVIDENCE Level I, therapeutic study.
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Oztuna V, Karatosun V, Unver B, Ayan I, Kuyurtar F. An alternative patellar resurfacing technique in knee replacement: patellofemoral fascial interposition arthroplasty. Knee Surg Sports Traumatol Arthrosc 2007; 15:1210-4. [PMID: 17619855 DOI: 10.1007/s00167-007-0375-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 06/04/2007] [Indexed: 02/08/2023]
Abstract
The present study reports the early clinical results of 38 osteoarthritic patients (38 knees) who were treated by total knee replacement in conjunction with patellofemoral fascial interposition arthroplasty (PFIA). After the femoral and tibial components were inserted, a fasciotendinous graft was harvested from the anterior surface of the quadriceps tendon and sutured around the articular surface of the patella. The patients were followed-up for a minimum of 24 months. The durability of the fascial graft was assessed radiographically by addition of a wire suture marker placed into the fascia in the first five patients. Patients were evaluated using the Hospital for Special Surgery (HSS) knee-rating system, and anterior knee pain was assessed using specific patellofemoral-related questions. The average HSS knee score improved from 61 points preoperatively to 92 points at 24 months' follow-up (P<0.001). Twenty-five patients (65.7%) had anterior knee pain preoperatively, and seven patients (18.4%) revealed anterior knee pain at their last visits (P<0.001). The position of the markers in the fascial grafts did not show any change during radiological follow-ups. Our data suggest that, PFIA provides good pain relief and it may be an alternative resurfacing technique avoiding the complications of patellar components.
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Affiliation(s)
- Volkan Oztuna
- Department of Orthopaedics, Mersin University School of Medicine, Viransehir Mah, 318 sokak, Moda Plaza, C Blok, D:10, Mersin, 33190, Turkey.
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Campbell DG, Duncan WW, Ashworth M, Mintz A, Stirling J, Wakefield L, Stevenson TM. Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. ACTA ACUST UNITED AC 2006; 88:734-9. [PMID: 16720765 DOI: 10.1302/0301-620x.88b6.16822] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A series of 100 consecutive osteoarthritic patients was randomised to undergo total knee replacement using a Miller-Galante II prosthesis, with or without a cemented polyethylene patellar component. Knee function was evaluated using the American Knee Society score, Western Ontario and McMaster University Osteoarthritis index, specific patellofemoral-related questions and radiographic evaluation until the fourth post-operative year, then via questionnaire until ten years post-operatively. A ten-point difference in the American Knee Society score between the two groups was considered a significant change in knee performance, with alpha and beta levels of 0.05. The mean age of the patients in the resurfaced group was 71 years (53 to 88) and in the non-resurfaced group was 73 years (54 to 86). After ten years 22 patients had died, seven were suffering from dementia, three declined further participation and ten were lost to follow-up. Two patients in the non-resurfaced group subsequently had their patellae resurfaced. In the resurfaced group one patient had an arthroscopic lateral release. There was no significant difference between the two treatment groups: both had a similar deterioration of scores with time, and no further patellofemoral complications were observed in either group. We are unable to recommend routine patellar resurfacing in osteoarthritic patients undergoing total knee replacement on the basis of our findings.
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Affiliation(s)
- D G Campbell
- The Queen Elizabeth Hospital, Woodville, Adelaide, South Australia.
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Perka C, Tohtz S, Matziolis G. Achskorrektur bei Knietotalendoprothesenrevisionen. DER ORTHOPADE 2006; 35:136-42. [PMID: 16362140 DOI: 10.1007/s00132-005-0905-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Implant malalignment is a major cause for early loosening, increased wear, painful limitation of motion, and patient dissatisfaction in total knee arthroplasty. Validated diagnostic algorithms and a deeper understanding of the pathological mechanisms underlying functional deficits and pain resulting from malalignment explain the increasing number of revision operations on unloosened prostheses, which are now nearly as common as revisions for implant loosening. Common reasons are component malpositioning are a shifted joint line, or a non-physiological patella position. The success of any revision procedure basically depends on: (1) correct component positioning, (2) equal and symmetrical flexion and extension gaps, (3) restoration of joint line, and (4) a physiological patella height. The adequate grade of implant constraint has to be determined intra-operatively. A higher loosening rate of constrained implants as well as increased wear and painful limitation of motion in case of instability have to be taken into account. In the present work, a diagnostic and therapeutic algorithm for malalignment of knee prostheses is presented.
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Affiliation(s)
- C Perka
- Zentrum für Muskuloskeletale Chirurgie, Orthopädische Klinik, Charité, Universitätsmedizin, Berlin.
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Mockford BJ, Beverland DE. Secondary resurfacing of the patella in mobile-bearing total knee arthroplasty. J Arthroplasty 2005; 20:898-902. [PMID: 16230242 DOI: 10.1016/j.arth.2005.02.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Revised: 09/21/2004] [Accepted: 02/03/2005] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE We aim to evaluate the impact of secondary patellar resurfacing in patients with patellar-related anterior knee pain who have undergone a mobile-bearing primary knee arthroplasty without resurfacing. MATERIALS A total of 2950 primary Low Contact Stress (DePuy, Warsaw, Ind) mobile-bearing knee arthroplasties without patellar resurfacing were carried out between March 1992 and March 2003. Thirteen patients (0.4%) underwent secondary patellar resurfacing for patellar-related anterior knee pain. The mean age of the patients was 67.8 years. There was a mean time of 28 months to the secondary resurfacing procedure. RESULTS Only 4 patients had an unequivocal improvement in their symptoms at a mean follow-up of 45 months (range, 3-92 months). No morbidity was noted from the procedure. CONCLUSION The success rate of secondary patellar resurfacing is poor and patients should be counseled carefully.
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Affiliation(s)
- Brian J Mockford
- Orthopedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
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