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Maniar AR, Luo TD, Somerville LE, MacDonald SJ, Naudie DDR, McCalden RW. Minimum 15-Year Survival of a Biconvex Inlay Patellar Component in Primary Total Knee Arthroplasty: An Analysis of 2,530 Total Knee Arthroplasties From a Single Institution. J Arthroplasty 2024:S0883-5403(24)00423-6. [PMID: 38710347 DOI: 10.1016/j.arth.2024.04.075] [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: 11/12/2023] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Routine patellar resurfacing during primary total knee arthroplasty (TKA) remains controversial. To our knowledge, there are no studies reporting the long-term performance of a cemented biconvex all-polyethylene inlay component implanted at the time of primary TKA. The purpose of this study was to examine the 15-year survivorship and long-term clinical outcomes of this biconvex inlay patella used at our institution. METHODS We retrospectively reviewed our prospectively collected institutional database and identified 2,530 patients who underwent cemented TKA with a single prosthetic design (from 1996 to 2007) where the patella was resurfaced using this cemented biconvex inlay patella. The mean age at surgery was 68 years (range, 29 to 93). The mean body mass index was 33.0 (range, 16.4 to 76.3), with 61.9% women. At the time of analysis, the mean time from surgery was 20.4 years (range, 15 to 26). We used Kaplan-Meier analysis to calculate survivorship at 15 years. We analyzed clinical outcomes using 3 patient-reported outcome measures collected prospectively. RESULTS The 15-year survivorship with revision surgery for all causes as the end point was 97.1% (95% confidence interval 96.1 to 98.1%). The 15-year survivorship with revision surgery for a patella-related complication as the end point was 99.7% (95% confidence interval 99.4 to 1.0). At the final follow-up, patients showed significant improvement in scores for the Knee Society Clinical Rating System (P < .001), Western Ontario and McMaster University Osteoarthritis Index (P < .001), and Veterans Rand 12-Item Health Survey physical component (P < .001). CONCLUSIONS Routine patellar resurfacing using a biconvex inlay patellar component has excellent survivorship and a low rate of complications at 15 years post-TKA.
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Affiliation(s)
- Adit R Maniar
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Science Centre, London, Ontario, Canada
| | - T David Luo
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Science Centre, London, Ontario, Canada; Orthopaedics Northeast, 5500 N Clinton St, Fort Wayne, IN 46825, USA
| | - Lyndsay E Somerville
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Science Centre, London, Ontario, Canada
| | - Steven J MacDonald
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Science Centre, London, Ontario, Canada
| | - Douglas D R Naudie
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Science Centre, London, Ontario, Canada
| | - Richard W McCalden
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Science Centre, London, Ontario, Canada
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Feng H, Feng ML, Cheng JB, Zhang X, Tao HC. Meta-analysis of factors influencing anterior knee pain after total knee arthroplasty. World J Orthop 2024; 15:180-191. [PMID: 38464355 PMCID: PMC10921178 DOI: 10.5312/wjo.v15.i2.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a mature procedure recommended for correcting knee osteoarthritis deformity, relieving pain, and restoring normal biomechanics. Although TKA is a successful and cost-effective procedure, patient dissatisfaction is as high as 50%. Knee pain after TKA is a significant cause of patient dissatisfaction; the most common location for residual pain is the anterior region. Between 4% and 40% of patients have anterior knee pain (AKP). AIM To investigate the effect of various TKA procedures on postoperative AKP. METHODS We searched PubMed, EMBASE, and Cochrane from January 2000 to September 2022. Randomized controlled trials with one intervention in the experimental group and no corresponding intervention (or other interventions) in the control group were collected. Two researchers independently read the title and abstract of the studies, preliminarily screened the articles, and read the full text in detail according to the selection criteria. Conflicts were resolved by consultation with a third researcher. And relevant data from the included studies were extracted and analyzed using Review Manager 5.4 software. RESULTS There were 25 randomized controlled trials; 13 were comparative studies with or without patellar resurfacing. The meta-analysis showed no significant difference between the experimental and control groups (P = 0.61). Six studies were comparative studies of circumpatellar denervation vs non-denervation, divided into three subgroups for meta-analysis. The two-subgroup meta-analysis showed no significant difference between the experimental and the control groups (P = 0.31, P = 0.50). One subgroup meta-analysis showed a significant difference between the experimental and control groups (P = 0.001). Two studies compared fixed-bearing TKA and mobile-bearing TKA; the results meta-analysis showed no significant difference between the experimental and control groups (P = 0.630). Two studies compared lateral retinacular release vs non-release; the meta-analysis showed a significant difference between the experimental and control groups (P = 0.002); two other studies compared other factors. CONCLUSION Patellar resurfacing, mobile-bearing TKA, and fixed-bearing TKA do not reduce the incidence of AKP. Lateral retinacular release can reduce AKP; however, whether circumpatellar denervation can reduce AKP is controversial.
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Affiliation(s)
- Hui Feng
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ming-Li Feng
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jing-Bo Cheng
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiang Zhang
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Hai-Cheng Tao
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Adam R, Moldovan C, Tudorache S, Hârșovescu T, Orban C, Pogărășteanu M, Rusu E. Patellar Resurfacing in Total Knee Arthroplasty, a Never-Ending Controversy; Case Report and Literature Review. Diagnostics (Basel) 2023; 13:diagnostics13030383. [PMID: 36766489 PMCID: PMC9914207 DOI: 10.3390/diagnostics13030383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/15/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
Total knee arthroplasty (TKA) remains a lifesaving procedure for advanced gonarthrosis. However, patella resurfacing (PR) in TKA remains a controversial procedure, leading to extensive discussions amongst orthopedic surgeons, regarding its indications and results. Based on these premises, we present a clinical case of a 70-year-old Caucasian woman admitted for pain, swelling and limitation of left knee joint mobility. Her medical history records an Ahlback stage IV gonarthrosis with simultaneous bilateral TKA surgery performed in different hospital, when two NexGen cemented total prostheses were implanted with patellar resurfacing being performed only on the right side. Our clinical (American Knee Society Score, Lonner and Feller scales) and radiological evaluations (CT scan and Xray) revealed left patellar arthrosis and a slight lateral subluxation of the patella. The chosen treatment plan was revision surgery for PR and patellar prosthesis with a cemented patellar component, cross-linked polyethylene, no 32 NexGen model with 8.5 mm thickness. The immediate and distant postoperative evolution was favorable. Extensive literature review shows that, at present, PR remains at surgeon's discretion mainly based on his previous results. Therefore, we believe there is an imperative need to develop high quality studies based on accurate scientific evidence to universally establish valid guidelines for PR in TKA.
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Affiliation(s)
- Răzvan Adam
- Department of Orthopedics and Traumatology, Elias Emergency University Hospital, 011461 Bucharest, Romania
- Department of First Aid and Disaster Medicine, Faculty of Medicine, Titu Maiorescu University of Bucharest, 040051 Bucharest, Romania
| | - Cosmin Moldovan
- Department of Clinical Sciences, General Surgery, Faculty of Medicine, Titu Maiorescu University of Bucharest, 040051 Bucharest, Romania
- Department of General Surgery, Witting Clinical Hospital, 010243 Bucharest, Romania
- Correspondence: (C.M.); (T.H.); Tel.: +40-723504207 (C.M.); +40-723234060 (T.H.)
| | - Sorin Tudorache
- Department of Preclinical Sciences, Anatomy and Embryology, Faculty of Medicine, Titu Maiorescu University of Bucharest, 040051 Bucharest, Romania
| | - Tudor Hârșovescu
- Department of Preclinical Sciences, Anatomy and Embryology, Faculty of Medicine, Titu Maiorescu University of Bucharest, 040051 Bucharest, Romania
- Correspondence: (C.M.); (T.H.); Tel.: +40-723504207 (C.M.); +40-723234060 (T.H.)
| | - Carmen Orban
- Department of Anesthesia and Intensive Care, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Intensive Care Unit Department, Monza Oncology Hospital, 013812 Bucharest, Romania
| | - Mark Pogărășteanu
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Orthopedics and Traumatology, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Elena Rusu
- Department of Preclinical Sciences, Biochemistry, Faculty of Medicine, Titu Maiorescu University of Bucharest, 040051 Bucharest, Romania
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Cankaya D, Inci F, Bilekli AB, Karakus D, Kahve Y, Erdem Y. Patellar resurfacing in total knee arthroplasty leads to better isokinetic performance. J Orthop Sci 2023; 28:195-199. [PMID: 34991940 DOI: 10.1016/j.jos.2021.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/04/2021] [Accepted: 10/12/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND For decades there have been concerns about patellar resurfacing (PR) in total knee arthroplasty (TKA) and the individual preference of the surgeon is still the main determinant of whether or not resurfacing is applied. According to preference, surgeons can be categorized in 3 main groups of those who usually, selectively, or rarely resurface. The aim of this prospective, randomized, controlled study was to compare the isokinetic performance and clinical outcome of TKAs with PR and without PR. METHODS A total of 50 patients scheduled to undergo TKA for primary osteoarthritis of the knee were randomly assigned to either the PR or non-PR groups. There were no significant differences between the groups in respect of age, BMI, gender and preoperative Knee Society Score (KSS) and isokinetic performance. Patients were evaluated at postoperative 3, 6, and 12 months with KSS and at 6 months and 1 year with isokinetic measurements. RESULTS The PR group had a higher mean score, especially in the functional component of KSS, but the difference was not statistically significant. Knee extension peak torque was significantly higher in the PR group at 6 months (p = 0.029) and 1 year (p = 0.004) postoperatively. There were no significant differences between the groups in respect of knee flexion peak torque values following TKA. CONCLUSIONS The results of this study demonstrated that PR during TKA is associated with better isokinetic performance and higher knee scores. These results support routine/usually resurfacing of the patella. For surgeons who selectively resurface the patella, the advantage of better isokinetic performance may be taking into consideration in favor of resurfacing the patella where they are undecided. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Deniz Cankaya
- Gulhane Teaching and Research Hospital, Department of Orthopaedic and Traumatology, Ankara, Turkey.
| | - Fatih Inci
- University of Health Sciences, Ankara City Hospital, Department of Orthopaedic and Traumatology, Turkey
| | - Ahmet Burak Bilekli
- Gulhane Teaching and Research Hospital, Department of Orthopaedic and Traumatology, Ankara, Turkey
| | - Dilek Karakus
- Ordu University, School of Medicine, Department of Physical Medicine and Rehabilitation, Ordu, Turkey
| | - Yakup Kahve
- University of Health Sciences, Ankara City Hospital, Department of Orthopaedic and Traumatology, Turkey
| | - Yusuf Erdem
- Gulhane Teaching and Research Hospital, Department of Orthopaedic and Traumatology, Ankara, Turkey
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Akti S, Cankaya D, Kilinc S, Oztemur Z, Ozturk H, Bulut O. Effect of patellar resurfacing surgery on bleeding in total knee arthroplasty. Rev Assoc Med Bras (1992) 2022; 68:1542-1546. [DOI: 10.1590/1806-9282.20220492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022] Open
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Grela M, Barrett M, Kunutsor SK, Blom AW, Whitehouse MR, Matharu GS. Clinical effectiveness of patellar resurfacing, no resurfacing and selective resurfacing in primary total knee replacement: systematic review and meta-analysis of interventional and observational evidence. BMC Musculoskelet Disord 2022; 23:932. [PMID: 36273138 PMCID: PMC9587662 DOI: 10.1186/s12891-022-05877-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Patellar resurfacing is optional during total knee replacement (TKR). Some surgeons always resurface the patella, some never resurface, and others selectively resurface. Which resurfacing strategy provides optimal outcomes is unclear. We assessed the effectiveness of patellar resurfacing, no resurfacing, and selective resurfacing in primary TKR. Methods A systematic review and meta-analysis was performed. MEDLINE, Embase, Web of Science, The Cochrane Library, and bibliographies were searched to November 2021 for randomised-control trials (RCTs) comparing outcomes for two or more resurfacing strategies (resurfacing, no resurfacing, or selective resurfacing) in primary TKR. Observational studies were included if limited or no RCTs existed for resurfacing comparisons. Outcomes assessed were patient reported outcome measures (PROMs), complications, and further surgery. Study-specific relative risks [RR] were aggregated using random-effects models. Quality of the evidence was assessed using GRADE. Results We identified 33 RCTs involving 5,540 TKRs (2,727 = resurfacing, 2,772 = no resurfacing, 41 = selective resurfacing). One trial reported on selective resurfacing. Patellar resurfacing reduced anterior knee pain compared with no resurfacing (RR = 0.65 (95% CI = 0.44–0.96)); there were no significant differences in PROMs. Resurfacing reduced the risk of revision surgery (RR = 0.63, CI = 0.42–0.94) and other complications (RR = 0.54, CI = 0.39–0.74) compared with no resurfacing. Quality of evidence ranged from high to very low. Limited observational evidence (5 studies, TKRs = 215,419) suggested selective resurfacing increased the revision risk (RR = 1.14, CI = 1.05–1.22) compared with resurfacing. Compared with no resurfacing, selective resurfacing had a higher risk of pain (RR = 1.25, CI = 1.04–1.50) and lower risk of revision (RR = 0.92, CI = 0.85–0.99). Conclusions Level 1 evidence supports TKR with patellar resurfacing over no resurfacing. Resurfacing has a reduced risk of anterior knee pain, revision surgery, and complications, despite PROMs being comparable. High-quality RCTs involving selective resurfacing, the most common strategy in the UK and other countries, are needed given the limited observational data suggests selective resurfacing may not be effective over other strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05877-7.
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Affiliation(s)
- Michal Grela
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-On-Trym, Bristol, BS10 5NB, UK
| | - Matthew Barrett
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-On-Trym, Bristol, BS10 5NB, UK
| | - Setor K Kunutsor
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-On-Trym, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-On-Trym, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-On-Trym, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
| | - Gulraj S Matharu
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-On-Trym, Bristol, BS10 5NB, UK.
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7
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Madry H. Surgical therapy in osteoarthritis. Osteoarthritis Cartilage 2022; 30:1019-1034. [PMID: 35183776 DOI: 10.1016/j.joca.2022.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To provide an evidence-based overview of the different surgical procedures in osteoarthritis (OA). DESIGN This narrative review reports on surgical therapies (1) for severe, end stage OA and (2) of surgical options aiming to possibly reduce OA development earlier in the course of the disease. RESULTS Surgical practice guidelines provide evidence-based recommendations to assist in the clinical decision-making. Total joint arthroplasty represents the only valuable, established surgical option for severe, end stage OA. For hip and knee OA, it is by far the most common surgical procedure and provides considerable pain relief, functional restoration, and improved quality of life. Surgical therapy aiming to postpone OA essentially addresses extra- or intraarticular pre-osteoarthritic deformities, defined as congenital or acquired disturbances of the joint structure that adversely affect its function. Approaches in this category include osteotomies and different cartilage repair procedures such as osteochondral autograft and allograft transfer, marrow stimulation techniques, and autologous chondrocyte implantation. However, they are not only less commonly performed than arthroplasty, but the scientific clinical evidence in favour of this type of surgery to reduce the long-term risk of developing OA is considerably reduced. CONCLUSION Total knee and hip arthroplasty are two of the most successful procedures in all of medicine. As the progression of this insidious disease is often asymptomatic and slow, it is imperative to judge reparative procedures at their potential to reduce OA development at long-term, besides their primary clinical outcomes. Evidence-based guidelines provide a valuable tool for high-quality surgical decision making in OA.
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Affiliation(s)
- H Madry
- Institute of Experimental Orthopaedics, Saarland University, Homburg, Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg, Saar, Germany.
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8
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Deroche E, Batailler C, Swan J, Sappey-Marinier E, Neyret P, Servien E, Lustig S. No difference between resurfaced and non-resurfaced patellae with a modern prosthesis design: a prospective randomized study of 250 total knee arthroplasties. Knee Surg Sports Traumatol Arthrosc 2022; 30:1025-1038. [PMID: 33661323 DOI: 10.1007/s00167-021-06521-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/22/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Despite numerous well-conducted studies and meta-analyses, the management of the patella during total knee arthroplasty (TKA) remains controversial. The aim of our study was to compare the clinical and radiological outcomes between patients with and without patellar resurfacing and to determine the influence of resurfacing on patellar tracking with a "patella-friendly" prosthesis. METHODS A single-centered prospective randomized controlled study was performed between April 2017 and November 2018. Two hundred and forty-five consecutive patients (250 knees) scheduled for TKA were randomized for patellar resurfacing or patella non-resurfacing. All patients received the same total knee prosthesis and were evaluated clinically and radiologically, including the International Knee Society Score (KSS knee and function), Forgotten Joint Score (FJS), anterior knee pain (AKP), pain when climbing stairs, patellar tilt, and patellar translation. RESULTS Two hundred and twenty-nine knees were available for clinical evaluation and 221 knees for radiographic analysis. The revision rate for patellofemoral cause was 3.1% (7 cases) with no difference between the groups (p = 0.217). There was no difference in survival rate between patellar resurfacing (88.3%) and non-resurfacing (85.3%) after 24 months (p = 0.599). There were no differences in KSS functional component (p = 0.599), KSS knee component (p = 0.396), FJS (p = 0.798), and AKP (p = 0.688) at a mean follow-up of 18 months. There was twice as much stair pain for the non-resurfacing group (17.1% versus 8.5%) (p = 0.043). There was patellar tilt in 43% of resurfaced knees (n = 50/116) versus 29% in non-resurfaced knees (n = 30/105) (p = 0.025); however, there was more patellar translation in the non-resurfaced group (21.0% versus 7.8%) (p < 0.001). There were no specific complications attributed to the patellar resurfacing procedure. There were four secondary patellar resurfacing procedures (3.6%) in the non-resurfaced group after a mean of 10 ± 7 months (1-17) postoperatively. CONCLUSION There is no superiority of patellar resurfacing or non-resurfacing in terms of clinical or radiological outcomes at mid-term. Secondary patellar resurfacing is rare. There is not enough evidence to recommend systematic patellar resurfacing with a "patella-friendly" prosthesis.
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Affiliation(s)
- Etienne Deroche
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.
| | - Cécile Batailler
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - John Swan
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Elliot Sappey-Marinier
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | | | - Elvire Servien
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
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9
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Huitema GC, de Vries LMA, Verboom TW, Spekenbrink-Spooren A, Steens J. Patella related problems as common reason for revision of NexGen PS® total knee arthroplasty without patella resurfacing: An analysis of 5911 primary total knee arthroplasties registered in the Dutch Arthroplasty Register. Knee 2022; 34:217-222. [PMID: 35030503 DOI: 10.1016/j.knee.2021.12.008] [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: 07/12/2021] [Revised: 10/29/2021] [Accepted: 12/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patella resurfacing remains controversial in primary total knee arthroplasty (TKA).The aim of this study was to investigate if there was a difference in revision rate and reason for revision within 8 years after single brand primary cemented TKA with or without patella resurfacing, using data from the Dutch Arthroplasty Register. METHODS All primary TKA surgeries with a posterior stabilized cemented primary NexGen®, between 2010 and 2013 with diagnosis osteoarthritis were analyzed (n = 5911). Multivariate cox regression analyses were performed to analyze differences in revision rate between TKA with or without patella component, and was adjusted for age and previous surgery. RESULTS Of 5911 TKA surgeries, 4795 were performed without patella resurfacing (81.1%) and 1116 with patella resurfacing (18.9%). There was a significant difference in patellar problems as reason for revision between patients after primary TKA with patella resurfacing (9.3%) and without patella resurfacing (29.9%) (p = 0.01). This was mostly caused by patellar pain (28.0%). There was no significant difference in cumulative revision rate within between TKA with patella resurfacing and without patella resurfacing. CONCLUSION In conclusion, 30% of patients who need revision surgery after TKA using NexGen® PS without patella resurfacing the reason for revision is patella related problems, compared to 9% after TKA NexGen® PS with patella resurfacing. There was no difference in cumulative incidence of revision after primary surgery of all TKA's using NexGen® PS with or without patella. To reduce the probability of reoperation for patella related problems, our data suggest the patella should be resurface during primary TKA.
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Affiliation(s)
- Gerian C Huitema
- Department of Orthopedic Surgery, Dijklander Hospital, Maelsonstraat 3, 1624NP, Hoorn and Purmerend, the Netherlands.
| | - Lieke M A de Vries
- Department of Orthopedic Surgery, Dijklander Hospital, Maelsonstraat 3, 1624NP, Hoorn and Purmerend, the Netherlands.
| | - Tom W Verboom
- Department of Orthopedic Surgery, Dijklander Hospital, Maelsonstraat 3, 1624NP, Hoorn and Purmerend, the Netherlands.
| | - Anneke Spekenbrink-Spooren
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), Bruistensingel 230, 5232 AD, 's Hertogenbosch, the Netherlands.
| | - Jeroen Steens
- Department of Orthopedic Surgery, Dijklander Hospital, Maelsonstraat 3, 1624NP, Hoorn and Purmerend, the Netherlands.
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10
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Fleaca S, Mohor C, Dura H, Chicea R, Mohor C, Boicean A, Roman M. Effect of patella resurfacing on functional outcome and revision rate in primary total knee arthroplasty (Review). Exp Ther Med 2021; 23:104. [DOI: 10.3892/etm.2021.11027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/21/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sorin Fleaca
- Department of Surgery, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Cosmin Mohor
- Department of Basic Science, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Horatiu Dura
- Department of Basic Science, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Radu Chicea
- Department of Surgery, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Calin Mohor
- Department of Basic Science, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Adrian Boicean
- Department of Medicine, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Mihai Roman
- Department of Surgery, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
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11
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McConaghy K, Derr T, Molloy RM, Klika AK, Kurtz S, Piuzzi NS. Patellar management during total knee arthroplasty: a review. EFORT Open Rev 2021; 6:861-871. [PMID: 34760286 PMCID: PMC8559560 DOI: 10.1302/2058-5241.6.200156] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The optimal management of the patella during total knee arthroplasty (TKA) remains controversial and surgeons tend to approach the patella with one of three general mindsets: always resurface the patella, never resurface the patella, or selectively resurface the patella based on specific patient or patellar criteria. Studies comparing resurfacing and non-resurfacing of the patella during TKA have reported inconsistent and contradictory findings. When resurfacing the patella is chosen, there are a number of available patellar component designs, materials, and techniques for cutting and fixation. When patellar non-resurfacing is chosen, several alternatives are available, including patellar denervation, lateral retinacular release, and patelloplasty. Surgeons may choose to perform any of these alone, or together in some combination. Prospective randomized studies are needed to better understand which patellar management techniques contribute to superior postoperative outcomes. Until then, this remains a controversial topic, and options for patellar management will need to be weighed on an individual basis per patient.
Cite this article: EFORT Open Rev 2021;6:861-871. DOI: 10.1302/2058-5241.6.200156
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Affiliation(s)
- Kara McConaghy
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Tabitha Derr
- Implant Research Core, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Robert M Molloy
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA
| | - Alison K Klika
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA
| | - Steven Kurtz
- Implant Research Core, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA.,Exponent, Philadelphia, Pennsylvania, USA
| | - Nicolas S Piuzzi
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA
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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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Hunt LP, Matharu GS, Blom AW, Howard PW, Wilkinson JM, Whitehouse MR. Patellar resurfacing during primary total knee replacement is associated with a lower risk of revision surgery. Bone Joint J 2021; 103-B:864-871. [PMID: 33934661 DOI: 10.1302/0301-620x.103b5.bjj-2020-0598.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Debate remains whether the patella should be resurfaced during total knee replacement (TKR). For non-resurfaced TKRs, we estimated what the revision rate would have been if the patella had been resurfaced, and examined the risk of re-revision following secondary patellar resurfacing. METHODS A retrospective observational study of the National Joint Registry (NJR) was performed. All primary TKRs for osteoarthritis alone performed between 1 April 2003 and 31 December 2016 were eligible (n = 842,072). Patellar resurfacing during TKR was performed in 36% (n = 305,844). The primary outcome was all-cause revision surgery. Secondary outcomes were the number of excess all-cause revisions associated with using TKRs without (versus with) patellar resurfacing, and the risk of re-revision after secondary patellar resurfacing. RESULTS The cumulative risk of all-cause revision at ten years was higher (p < 0.001) in primary TKRs without patellar resurfacing (3.54% (95% confidence interval (CI) 3.47 to 3.62)) compared to those with resurfacing (3.00% (95% CI 2.91 to 3.11)). Using flexible parametric survival modelling, we estimated one 'excess' revision per 189 cases performed where the patella was not resurfaced by ten years (equivalent to 2,842 excess revisions in our cohort). The risk of all-cause re-revision following secondary patellar resurfacing was 4.6 times higher than the risk of revision after primary TKR with patellar resurfacing (at five years from secondary patellar resurfacing, 8.8% vs 1.9%). CONCLUSION Performing TKR without patellar resurfacing was associated with an increased risk of revision. Secondary patellar resurfacing led to a high risk of re-revision. This represents a potential substantial healthcare burden that should be considered when forming treatment guidelines and commissioning services. Cite this article: Bone Joint J 2021;103-B(5):864-871.
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Affiliation(s)
- Linda P Hunt
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gulraj S Matharu
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | | | - J Mark Wilkinson
- Department of Oncology and Metabolism, The University of Sheffield, Sorby Wing, Northern General Hospital, Sheffield, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
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Young SW, Maney AJ, Frampton CM. Reply to Letter to the Editor on "Age and Prosthetic Design as Risk Factors for Secondary Patella Resurfacing". J Arthroplasty 2020; 35:3062. [PMID: 32741706 DOI: 10.1016/j.arth.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/05/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Simon W Young
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Alistair J Maney
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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CORR Insights®: Does Circumferential Patellar Denervation Result in Decreased Knee Pain and Improved Patient-reported Outcomes in Patients Undergoing Nonresurfaced, Simultaneous, Bilateral TKA? Clin Orthop Relat Res 2020; 478:2034-2035. [PMID: 31855592 PMCID: PMC7431240 DOI: 10.1097/corr.0000000000001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Maney AJ, Frampton CM, Young SW. Age and Prosthetic Design as Risk Factors for Secondary Patella Resurfacing. J Arthroplasty 2020; 35:1563-1568. [PMID: 32037214 DOI: 10.1016/j.arth.2020.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/19/2019] [Accepted: 01/09/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Selectively resurfacing the patella based on a patient's risk of secondary patella resurfacing (SPR) may be the optimal strategy for primary total knee arthroplasty (TKA). However, exactly which factors increase the risk of SPR is unknown. Utilizing New Zealand Joint Registry data, we investigated the following: (1) What patient and surgical factors are more prevalent among TKA patients who received SPR compared to those who did not? and (2) What is the difference in Oxford Knee Scores (OKS) between those who receive SPR and those who do not? METHODS Prevalence of various patient and surgical factors was compared between 197 non-resurfaced TKAs that proceeded to SPR and 31,399 that did not. Multivariate analysis was used to determine the odds ratio for each factor that differed between groups. Six-month postoperative OKS for each group was utilized for comparison. RESULTS Posterior-stabilized designs had an odds ratio of 1.86 (95% confidence interval [CI] 1.31-2.66; P = .001) when compared to cruciate-retaining designs. When compared to age less than 55, age >75 and age 65-74 had odds ratios of 0.27 (95% CI 0.16-0.46; P < .001) and 0.44 (95% CI 0.28-0.69; P < .001) respectively. Six-month OKS was lower among those who received SPR (37.27 vs 27.26; P < .001). CONCLUSION Younger age, posterior-stabilized design, and a low 6-month OKS were associated with SPR.
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Affiliation(s)
- Alistair J Maney
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Simon W Young
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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Roberts TD, Frampton CM, Young SW. Outcomes of Computer-Assisted Surgery Compared with Conventional Instrumentation in 19,221 Total Knee Arthroplasties: Results After a Mean of 4.5 Years of Follow-Up. J Bone Joint Surg Am 2020; 102:550-556. [PMID: 31977812 DOI: 10.2106/jbjs.19.00852] [Citation(s) in RCA: 12] [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 Studies have shown improved alignment in association with the use of computer-assisted surgery (CAS) as compared with conventional instrumentation during total knee arthroplasty (TKA) but have failed to show a consistent clinical benefit. The aim of the present study was to compare the revision rates and functional outcomes following TKA performed with either CAS or conventional instrumentation. Recognizing that selection bias may arise from the preferential use of CAS in difficult or complex cases, the implant survival data and postoperative functional scores were analyzed with reference to whether the surgeon routinely performed TKA with use of CAS or conventional instrumentation. METHODS Revision rates and functional data in terms of the Oxford Knee Score (OKS) at 6 months, 5 years, and 10 years were obtained from the New Zealand Joint Registry (NZJR) for 19,221 TKAs performed from 2006 to 2018.These data were analyzed by comparing 2 cohorts of patients: those managed by high-volume surgeons who routinely used CAS ("routine CAS" surgeons) and those managed by high-volume surgeons who routinely used conventional instrumentation ("routine conventional" surgeons). The mean duration of follow-up was 4.5 years (range, 0 to 12 years). RESULTS The revision rate per 100 component-years was 0.437 for the "routine CAS" surgeons, compared with 0.440 for the "routine conventional" surgeons (p = 0.724). For patients <65 years of age, the revision rate per 100 component-years was equivalent for the "routine CAS" and "routine conventional" surgeons (0.585 compared with 0.508; p = 0.524). The OKS scores were similar at 6 months (38.88 compared with 38.52; p = 0.172), 5 years (42.26 compared with 41.77; p = 0.206), and 10 years (41.59 compared with 41.74; p = 0.893) when comparing the 2 cohorts. Surgeons who had performed >50 TKAs with use of CAS took 10 minutes longer on average than those who used conventional instrumentation (92 compared with 82 minutes; p = 0.012). CONCLUSIONS The present study demonstrated no difference in survivorship or functional outcome scores to support using CAS for TKA. Experienced surgeons using CAS had longer operative durations than comparable surgeons using conventional instrumentation. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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