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Liu L, Li J, Wang Y, Li X, Han P, Li X. Different modalities of patellar management in primary total knee arthroplasty: a Bayesian network meta-analysis of randomized controlled trials. J Orthop Surg Res 2024; 19:74. [PMID: 38233873 DOI: 10.1186/s13018-024-04546-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The primary management modalities for the patella in TKA include patellar resurfacing, patellar non-resurfacing, patellar resurfacing with denervation, and patellar non-resurfacing with denervation. Traditionally, meta-analyses have predominantly focused on examining comparisons between two management modalities. However, this study performed a network meta-analysis to compare all four patellar management interventions to identify the most optimal approach for patellar management in TKA. METHODS A computer-based search of PubMed, China National Knowledge Infrastructure (CNKI), The Cochrane Library, Web of science, Embase, and MEDLINE databases was performed to identify randomized controlled trials focusing on the four management interventions for the patella in TKA. Comparisons included two-by-two comparisons as well as those involving more than two concurrent comparisons. The search timeframe spanned from inception to June 30, 2023. Two independent authors extracted the data and evaluated the quality of the literature. The Cochrane Collaboration Risk of Bias (ROB) tool was used to evaluate the overall quality of the literature. Subsequently, a network meta-analysis was conducted using the "gemtc" package of the R-4.2.3 software. Outcome measures such as anterior knee pain (AKP), reoperation rate, and patient satisfaction rate were evaluated using odd ratio (OR) and 95% confidence intervals (CI). Additionally, the knee society score (KSS), function score (FS), and range of motion (ROM) were evaluated using mean differences (MD) with associated 95% CI. The different treatment measures were ranked using the surfaces under the cumulative ranking curves (SUCRA). RESULTS A total of 50 randomized controlled trials involving 9,283 patients were included in the analysis. The findings from this network meta-analysis revealed that patellar resurfacing exhibited significantly lower postoperative reoperation rate (OR 0.44, 95% CI 0.24-0.63) and AKP (OR 0.58, 95% CI 0.32-1) compared to non-resurfacing. Additionally, patellar resurfacing exhibited higher postoperative KSS clinical scores in comparison with non-resurfacing (MD: 1.13, 95% CI 0.18-2.11). However, for postoperative FS, ROM, and patient satisfaction, no significant differences were observed among the four management interventions. CONCLUSION Patellar resurfacing emerges as the optimal management modality in primary TKA. However, future studies should aim to reduce sources of heterogeneity and minimize the influence of confounding factors on outcomes. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023434418 identifier: CRD42023434418.
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Affiliation(s)
- Lun Liu
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, No. 83, Heping West Street, Changzhi, 046000, Shanxi, China
- Graduate School, Changzhi Medical College, No. 161, Jiefang East Street, Changzhi, 046000, Shanxi, China
| | - Juebei Li
- Graduate School, Huazhong University of Science and Technology, No. 13, Hangkong Road, Wuhan, 430000, Hubei, China
| | - Yunlu Wang
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, No. 83, Heping West Street, Changzhi, 046000, Shanxi, China
- Graduate School, Changzhi Medical College, No. 161, Jiefang East Street, Changzhi, 046000, Shanxi, China
| | - Xiyong Li
- Graduate School, Changzhi Medical College, No. 161, Jiefang East Street, Changzhi, 046000, Shanxi, China
- Department of Orthopaedics, Heping Hospital Affiliated To Changzhi Medical College, No. 110, Yan'an South Road, Changzhi, 046000, Shanxi, China
| | - Pengfei Han
- Department of Orthopaedics, Heping Hospital Affiliated To Changzhi Medical College, No. 110, Yan'an South Road, Changzhi, 046000, Shanxi, China.
| | - Xiaodong Li
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, No. 83, Heping West Street, Changzhi, 046000, Shanxi, China.
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Chareancholvanich K, Chatmaitri S, Benjawilaikul S, Ruangsomboon P, Narkbunnam R, Pornrattanamaneewong C. To resurface or not to resurface? Investigating the impact of patellar resurfacing on anterior knee pain in rheumatoid arthritis patients undergoing total knee replacement. Knee 2023; 45:11-17. [PMID: 37729669 DOI: 10.1016/j.knee.2023.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/28/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Routine patellar resurfacing is a controversial issue in total knee replacement (TKR), especially for rheumatoid arthritis (RA). Anterior knee pain (AKP) is a common complaint after TKR that may be related to patellofemoral joint condition. The aim of this study was to investigate the prevalence and factors associated with AKP after TKR for RA compared between non-resurfaced patella (NRP) and resurfaced patella (RP). METHODS This retrospective study included RA patients who underwent TKR at our institute from 2002 to 2019. All included patients had at least 1 year of follow up. Patients were divided into the NRP and RP groups. At the last follow up visit, the prevalence of AKP, and the severity of AKP, including visual analogue pain score (VAPS) and Kujala score, were compared between groups. Univariate and multivariate logistic regression analysis was performed to identify independent predictors of AKP. RESULTS A total of 141 RA patients (median age: 60 years, 90% female, 219 knees) were included. There was no significant difference in AKP between the NRP and RP groups (12.7% vs. 7.3%, P = 0.185). Regarding AKP severity, there was no significant difference in VAPS or Kujala score between groups (P = 0.147 and P = 0.067, respectively). No independent predictors of AKP were identified. CONCLUSION Although patellar resurfacing is recommended in TKR for RA, this study found no significant difference in prevalence of AKP, VAPS and Kujala score between those with and without patellar resurfacing during TKR.
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Affiliation(s)
- Keerati Chareancholvanich
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Swist Chatmaitri
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sutthichon Benjawilaikul
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pakpoom Ruangsomboon
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rapeepat Narkbunnam
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chaturong Pornrattanamaneewong
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Tammachote N, Kraisin T, Kanitnate S. Do we need to restore patellar thickness after total knee arthroplasty with patellar resurfacing? Eur J Orthop Surg Traumatol 2023; 33:3677-3682. [PMID: 37291460 DOI: 10.1007/s00590-023-03607-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE The aim of this study was to investigate whether increased patellar thickness after resurfacing decreased knee flexion angle and had any effect on functional outcomes comparing with patellar thickness restoration (patelloplasty) in patients undergoing primary total knee arthroplasty (TKA) or not. METHODS We retrospectively reviewed 220 patients undergoing primary TKA: 110 patients undergoing patelloplasty and 110 patients received overstuffed patellar resurfacing using subchondral bone cut at lateral facet technique were recruited. The mean increase in patellar thickness after resurfacing equal to 2 ± 1.2 mm. The outcomes were postoperative knee flexion angle and modified Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score at minimum 2 year after surgery. RESULTS The mean postoperative knee flexion angles were similar between overstuffed resurfacing group and patelloplasty group (132 ± 7° vs. 134 ± 8°, 95% confidence interval [CI] - 6.9-1.8°, p = 0.1). The mean increase in postoperative knee flexion was 13° in both groups (p = 0.94). The mean change of overall modified WOMAC score was also similar between the two groups (42 ± 12 vs. 39 ± 9 points, 95% CI - 1.7-9.4 points, p = 0.17). CONCLUSION This study demonstrated that increased patellar thickness has no effect on postoperative knee flexion angle and functional outcomes in TKA. The finding clarified the misunderstanding principle of native patellar thickness restoration after resurfacing which had made many surgeons to refrain from resurfacing especially in patient who had thin patella.
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Affiliation(s)
- Nattapol Tammachote
- Investigation Performed at the Orthopedic Unit, Thammasat University Hospital, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand.
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand.
| | - Teeramate Kraisin
- Investigation Performed at the Orthopedic Unit, Thammasat University Hospital, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
| | - Supakit Kanitnate
- Investigation Performed at the Orthopedic Unit, Thammasat University Hospital, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
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Goicoechea N, Hinarejos P, Gasol B, Torres-Claramunt R, Sánchez-Soler J, Perelli S, Monllau JC. Systematic lateral retinacular release does not reduce anterior knee pain after total knee arthroplasty with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2023; 31:4213-4219. [PMID: 37270463 DOI: 10.1007/s00167-023-07456-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/13/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE The aim of this study was to assess the effect of systematic lateral retinacular release (LRR) on anterior knee pain (AKP), as well as its impact on the functional and radiological outcomes after total knee arthroplasty (TKA) with patellar resurfacing. METHODS A prospective randomized study was designed. It included patients scheduled for a TKA procedure with patellar resurfacing, who were recruited and randomized into either the LRR group or the non-release group. 198 patients were included in the final analysis. The pressure pain threshold (PPT) assessed by pressure algometry (PA), the visual analogue scale (VAS), Feller's patellar score, the Knee Society Score (KSS), patellar height, and patellar tilt were recorded both preoperatively and at the 1-year follow-up. The Mann-Whitney U test was performed to determine comparisons between both groups as well as to determine differences' intragroup. RESULTS Relative to the clinical variables and scores, no difference was detected between the two groups at the 1-year follow-up (p = n.s.). However, there was a slight difference in patellar tilt (0.1º vs. 1.4º, p = 0.044), with higher tilt values in the non-release group. There was no difference in terms of improvement in the clinical and radiological scores and variables recorded between the two groups (p = n.s.). CONCLUSION LRR in primary TKA with patellar resurfacing does not show an improvement in AKP and functional outcomes over patellar resurfacing without release. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Nerea Goicoechea
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain.
| | - Pedro Hinarejos
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Berta Gasol
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Raul Torres-Claramunt
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Juan Sánchez-Soler
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Simone Perelli
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Joan Carles Monllau
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Barahona M, Barrientos C, Alegría A, Barahona MA, Navarro T, Hinzpeter J, Palet M, Zamorano Á, Catalán J, Infante C. Anterior knee pain and sit-up tests predicts patients' satisfaction and improvement in quality of life after anterior stabilized total knee replacement without patellar resurfacing. J Exp Orthop 2023; 10:73. [PMID: 37493976 PMCID: PMC10371966 DOI: 10.1186/s40634-023-00641-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023] Open
Abstract
PURPOSE The purpose of this study was to assess patient satisfaction and identify risk factors for dissatisfaction after anterior stabilised conventional total knee arthroplasty (TKA) without patellar resurfacing, using the Goodman score. METHODS We conducted a cross-sectional study using data from our institutional database from 1 January 2018 to 1 March 2021. Patients who underwent TKA with the Vanguard® Cruciate Retaining Anterior Stabilized Knee System (Zimmer Biomet, Warsaw, Indiana, USA) without patellar replacement were included. Patients with other bearing surfaces (posterior stabilised or medial congruent) or diagnosed with infection or instability were excluded. Patients' reported outcomes, body mass index (BMI), passive range of motion, the timed up-and-go test, sit-up test, and algometry were assessed. Patients were also asked if they had anterior knee pain. Satisfaction was assessed using the Goodman scale, and logistic multivariate regression was used to identify variables associated with dissatisfaction and perceived improvement in quality of life. RESULTS A total of 131 TKA patients were included in the study. The median satisfaction score was 100 (interquartile range [IQR], 87.5 to 100), with the 75-point threshold at the 90th percentile according to Section A of Goodman. Section B of Goodman showed that 113 TKA patients (86.26%) reported "great improvement" or "more than I ever dreamed." Multivariate logistic regression revealed that anterior knee pain (OR 5.16, 95% CI 1.24 to 21.39), the sit-up test (OR 0.63, 95% CI 0.49 to 0.81), and BMI (OR 0.84, 95% CI 0.70 to 0.99) were significantly associated with patient dissatisfaction and a worse perceived improvement in quality of life. The receiver operating characteristics curve for the models had areas under the curve of 0.83 (95% CI 0.69 to 0.97) and 0.82 (95% CI 0.70 to 0.94), respectively. CONCLUSION Anterior stabilised TKA without patellar resurfacing can achieve 90% satisfaction and 86% improvement in quality of life. To improve these results, it is essential to prevent and treat anterior knee pain and enhance quadriceps strength. LEVEL OF EVIDENCE Level III (retrospective cohort study).
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Affiliation(s)
- Maximiliano Barahona
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile.
| | - Cristian Barrientos
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Anselmo Alegría
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Macarena A Barahona
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Tomas Navarro
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Jaime Hinzpeter
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Miguel Palet
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Álvaro Zamorano
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Jaime Catalán
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Carlos Infante
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
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Shah OA, Spence C, Kader D, Clement ND, Asopa V, Sochart DH. Patellar resurfacing and kneeling ability after total knee arthroplasty: a systematic review. Arthroplasty 2023; 5:32. [PMID: 37268994 DOI: 10.1186/s42836-023-00184-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/31/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Difficulty kneeling following total knee arthroplasty (TKA) remains highly prevalent, and has cultural, social, and occupational implications. With no clear evidence of superiority, whether or not to resurface the patella remains debatable. This systematic review examined whether resurfacing the patella (PR) or not (NPR) influences kneeling ability following TKA. METHODS This systematic review was conducted by following PRISMA guidelines. Three electronic databases were searched utilizing a search strategy developed with the aid of a department librarian. Study quality was assessed using MINROS criteria. Article screening, methodological quality assessment and data extraction were performed by two independent authors, and a third senior author was consulted if consensus was not reached. RESULTS A total of 459 records were identified, with eight studies included in the final analysis, and all deemed to be level III evidence. The average MINORS score was 16.5 for comparative studies and 10.5 for non-comparative studies. The total number of patients was 24,342, with a mean age of 67.6 years. Kneeling ability was predominantly measured as a patient-reported outcome measure (PROM), with two studies also including an objective assessment. Two studies demonstrated a statistically significant link between PR and kneeling, with one demonstrating improved kneeling ability with PR and the other reporting the opposite. Other potential factors associated with kneeling included gender, postoperative flexion, and body mass index (BMI). Re-operation rates were significantly higher in the NPR cohort whereas PR cohorts had higher Feller scores, patient-reported limp and patellar apprehension. CONCLUSION Despite its importance to patients, kneeling remains not only under-reported but also ill-defined in the literature, with no clear consensus regarding the optimum outcome assessment tool. Conflicting evidence remains as to whether PR influences kneeling ability, and to clarify the situation, large prospective randomized studies are required.
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Affiliation(s)
- Owais A Shah
- South West London Elective Orthopaedic Centre, Epsom, KT18 7EG, UK.
| | | | - Deiary Kader
- South West London Elective Orthopaedic Centre, Epsom, KT18 7EG, UK
| | - Nick D Clement
- South West London Elective Orthopaedic Centre, Epsom, KT18 7EG, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Vipin Asopa
- South West London Elective Orthopaedic Centre, Epsom, KT18 7EG, UK
| | - David H Sochart
- South West London Elective Orthopaedic Centre, Epsom, KT18 7EG, UK
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Simpson CJ, Ng N, Ndou S, Wright E, Yap NJ, Scott CEH, Clement ND. Patellar resurfacing was not associated with a clinically significant advantage when a modern patellar friendly total knee arthroplasty is employed: A systematic review and meta-analysis. Knee 2023; 41:329-41. [PMID: 36827957 DOI: 10.1016/j.knee.2023.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Modern total knee arthroplasty (TKA) femoral components are designed to provide a more optimal articular surface for the patella whether or not it has been resurfaced. Previous systematic reviews comparing outcomes of patellar resurfacing and no resurfacing combine both historic and modern designs. AIMS The aim of this study was to investigate the effect of patellar resurfacing in modern "patellar friendly" implants on (1) incidence of anterior knee pain, (2) patient reported outcomes (3) complication rates, and (4) reoperation rates compared with unresurfaced patellae in primary TKA. METHODS MEDline, PubMed and google scholar studies were evaluated using SIGN assessment tool and data analysis was conducted using Review Manager 5.2 on only randomised controlled trials. The search terms were: arthroplasty, replacement, knee (Mesh), TKA, prosthesis, patella, patellar resurfacing, patellar retaining. RESULTS Thirty-two randomised controlled studies were identified that reported the type of TKA implant used: 11 used modern "patellar friendly" implants; and 21 older "patellar non-friendly" implants. Among "patellar friendly" TKAs there were no significant differences in anterior knee pain rates between resurfaced and unresurfaced groups. Patellar resurfacing with "patellar friendly" implants had significantly higher clinical (mean difference (MD) -0.77, p = 0.007) and functional (MD -1.87, p < 0.0001) knee society scores (KSS) than unresurfaced counterparts but these did not exceed the minimal clinically important difference (MCID). Resurfacing with "patellar friendly" implants was not associated with a significant (p = 0.59) difference in the Oxford knee score (OKS), in contrast when a "patellar non-friendly" implant was used there was a significant difference (MD 3.3, p = 0.005) in favour of resurfacing. There was an increased risk of reoperation for unresurfaced TKAs with "non-patellar friendly" implants (Odds ratio (OR) 1.68, 95% CI 1.03-2.74, p = 0.04), but not for unresurfaced patellae with "patellar friendly" implants (OR 1.17, CI 0.59-2.30). CONCLUSIONS Patellar resurfacing in combination with a modern patellar friendly implant was not associated with a lower rate of anterior knee pain, complications, or reoperations compared to not resurfacing, nor did it give a clinically significant improvement in knee specific function. In contrast patellar resurfacing in combination with a "non-friendly" TKA implant was associated with a significantly better OKS and lower reoperation rate. Implant design should be acknowledged when patellar resurfacing is being considered.
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Tang X, He Y, Pu S, Lei L, Ning N, Shi Y, Chen J, Zhou Z. Patellar Resurfacing in Primary Total Knee Arthroplasty: A Meta-analysis and Trial Sequential Analysis of 50 Randomized Controlled Trials. Orthop Surg 2022; 15:379-399. [PMID: 36479594 PMCID: PMC9891932 DOI: 10.1111/os.13392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE During total knee arthroplasty, femur and tibia parts are regularly replaced, while resurfacing the patellar or not is an ongoing discussion. To compare revision rate, anterior knee pain rate, patient-reported outcome measures, complication, radiographic, and clinical outcomes after patellar resurfacing versus non-resurfacing in total knee arthroplasty. METHODS PubMed, Medline, EMBASE, CENTRAL, and CINAHL databases were searched on 25 April 2021 to enroll randomized controlled trials that compared patellar resurfacing versus non-resurfacing. We used the grading of recommendations assessment, development and evaluation (GRADE) framework to assess the certainty of evidence. Our primary outcome was revision rate and secondary outcomes was anterior knee pain rate. Outcomes were pooled using the random-effect model and presented as risk ratio (RR), or mean difference (MD), with 95% confidence interval (CI). RESULTS Fifty studies (5586 knees) were included. Significant reductions in patellar revision rate (RR 0.41, 95% CI [0.19, 0.88]; P = 0.02; I2 = 24.20%) and non-patellar revision rate (RR 0.64, 95% CI [0.55, 0.75]; P < 0.001; I2 = 0%) were seen after patellar resurfacing. Patellar resurfacing significantly reduced the anterior knee pain rate than nonresurfacing (RR 0.72, 95% CI [0.57, 0.91]; P = 0.006; I2 = 69.5%). Significant differences in patient-reported outcome measures were found. However, these differences were inconsistent and lacked clinical importance. Patellar resurfacing resulted in a significant lower rate of patellar clunk (RR 0.58, 95% CI [0.38, 0.88]; P = 0.01; I2 = 0%), a higher patellar score (MD 1.24, 95% CI [0.67, 0.81]; P < 0.001; I2 = 73.8%), but prolonged surgical time (MD 8.59, 95% CI [5.27, 11.91]; P < 0.001; I2 = 88.8%). CONCLUSIONS The clear relationship is that patellar resurfacing reduces revisions, anterior knee pain, and patellar clunk. It will be interesting to compare the initial cost with the revision cost when required and cost-utility analysis with long-term results in future studies.
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Affiliation(s)
- Xiumei Tang
- West China School of Nursing, Sichuan University/Department of OrthopedicsWest China Hospital, Sichuan UniversityChengduChina
| | - Yue He
- West China School of Nursing, Sichuan University/Department of OrthopedicsWest China Hospital, Sichuan UniversityChengduChina
| | - Shi Pu
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Lei Lei
- West China School of Nursing, Sichuan University/Department of OrthopedicsWest China Hospital, Sichuan UniversityChengduChina
| | - Ning Ning
- West China School of Nursing, Sichuan University/Department of OrthopedicsWest China Hospital, Sichuan UniversityChengduChina
| | - Yu Shi
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Jiali Chen
- West China School of Nursing, Sichuan University/Department of OrthopedicsWest China Hospital, Sichuan UniversityChengduChina
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital/West China School of MedicineSichuan UniversityChengduChina
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kono K, Tomita T, Yamazaki T, Iwamoto K, Tamaki M, D'Lima DD. Patellar resurfacing has minimal impact on in vitro tibiofemoral kinematics during deep knee flexion in total knee arthroplasty. Knee 2021; 30:163-169. [PMID: 33932828 DOI: 10.1016/j.knee.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND While patellar resurfacing can affect patellofemoral kinematics, the effect on tibiofemoral kinematics is unknown. We hypothesized that patellar resurfacing would affect tibiofemoral kinematics during deep knee flexion due to biomechanical alteration of the extensor mechanism. METHODS We performed cruciate-retaining TKA in fresh-frozen human cadaveric knees (N = 5) and recorded fluoroscopic kinematics during deep knee flexion before and after the patellar resurfacing. To simulate deep knee flexion, cadaver knees were tested on a dynamic, quadriceps-driven, closed-kinetic chain simulator based on the Oxford knee rig design under loads equivalent to stair climbing. To measure knee kinematics, a 2-dimensional to 3-dimensional fluoroscopic registration technique was used. Component rotation, varus-valgus angle, and anteroposterior translation of medial and lateral contact points of the femoral component relative to the tibial component were calculated over the range of flexion. RESULTS There were no significant differences in femoral component external rotation (before patellar resurfacing: 6.6 ± 2.3°, after patellar resurfacing: 7.2 ± 1.8°, p = 0.36), and less than 1° difference in femorotibial varus-valgus angle between patellar resurfacing and non-resurfacing (p = 0.01). For both conditions, the medial and lateral femorotibial contact points moved posteriorly from 0° to 30° of flexion, but not beyond 30° of flexion. At 10° of flexion, after patellar resurfacing, the medial contact point was more anteriorly located than before patellar resurfacing. CONCLUSION Despite the potential for alteration of the knee extensor biomechanics, patellar resurfacing had minimal effect on tibiofemoral kinematics. Patellar resurfacing, if performed adequately, is unlikely to affect postoperative knee function.
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Affiliation(s)
- Kenichi Kono
- Department of Molecular Medicine Arthritis Research, The Scripps Research Institute, CA, USA; Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takaharu Yamazaki
- Department of Information Systems, Faculty of Engineering, Saitama Institute of Technology, Saitama, Japan
| | - Keiji Iwamoto
- Department of Orthopaedic Surgery, Osaka Medical Center, Osaka, Japan
| | - Masashi Tamaki
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Darryl D D'Lima
- Department of Molecular Medicine Arthritis Research, The Scripps Research Institute, CA, USA; Shiley Center for Orthopaedic Research and Education at Scripps Clinic, CA, USA.
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13
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Apple AE, Montgomery CO, Mears SC. Tibial Osteolysis After Long-Term Isolated Polyethylene Patellar Resurfacing. Arthroplast Today 2021; 8:211-215. [PMID: 33937460 PMCID: PMC8076617 DOI: 10.1016/j.artd.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022] Open
Abstract
Isolated patellar resurfacing served as an early treatment for patellofemoral arthritis but was abandoned because of erosion of the native femoral trochlear groove over time. We present the case of a large native tibial osteolytic lesion 20 years after isolated patellar resurfacing with a cemented polyethylene component. The patient had severe tricompartmental arthritic changes. The patellar component was very worn, and the resultant particle debris produced a large cavitary lesion in the proximal tibia. Osteolysis is a rare complication in patellofemoral arthroplasty, and, to our knowledge, this is the first reported case of native tibial osteolysis after isolated patellar resurfacing. The patient was treated with initial curettage and bone grafting of the lesion followed by total knee arthroplasty with a tibial cone and stemmed tibial fixation.
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Affiliation(s)
- Andrew E Apple
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Corey O Montgomery
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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14
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Joseph L, Batailler C, Roger J, Swan J, Servien E, Lustig S. Patellar component size effects patellar tilt in total knee arthroplasty with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2021; 29:553-562. [PMID: 32274550 DOI: 10.1007/s00167-020-05984-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/06/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Patellar component positioning and patellofemoral kinematics are of great importance in total knee arthroplasty (TKA). The factors influencing patellar tilt are femoral rotation and lateral patellar release. However, the effect of patellar component size remains unknown. The aim of this study was to evaluate the intra-operative risk factors for patellar tilt, particularly the effect of the patellar component size. The hypothesis was that increasing the patellar component size would reduce the risk of patellar tilt. METHODS 878 primary TKAs with patellar resurfacing were included between January 2015 and October 2018. Analysis was performed at 1-year postoperatively on patients categorized into two groups: patellar tilt (PT) and no patellar tilt (NPT). A multivariate analysis was performed for the effect of patellar component size, femoral rotation, femoral overbuilding, patellar thickness and lateral release on patellar tilt risk. Secondary analysis was performed for any difference in clinical outcomes and revision rates between groups. RESULTS Multivariate analysis showed that increasing the patellar component size decreased the risk of patellar tilt by 37% (p < 0.001). Placing the femoral component at 3° of external rotation decreased the risk of patellar tilt by 67% (p < 0.001). Secondary analysis showed better clinical outcomes in the NPT group, especially regarding global satisfaction, and KSS objective and subjective scores. The revision for any cause was less in the NPT group (p = 0.019). The cause for TKA revision was related to the patellar in 11% of cases in the NPT group and 65% in the PT group (p < 0.001). CONCLUSION Increased patellar component size and positioning the femoral component in external rotation decreases the risk of patellar tilt, improves clinical outcomes and decreases the rate of surgical revision. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Léopold Joseph
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.
| | - Julien Roger
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - John Swan
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Elvire Servien
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
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Chen K, Dai X, Li L, Chen Z, Cui H, Lv S. Patellar resurfacing versus nonresurfacing in total knee arthroplasty: an updated meta-analysis of randomized controlled trials. J Orthop Surg Res 2021; 16:83. [PMID: 33494774 PMCID: PMC7830853 DOI: 10.1186/s13018-020-02185-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/25/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Whether resurface the patella or not in total knee arthroplasty (TKA) was controversial. In 2013, we conducted a meta-analysis of randomized controlled trials (RTCs). After that, plenty of studies have been carried out, but there still existed a great deal of controversy. In order to update our previous study, we conducted this update meta-analysis to evaluate the efficacy of patellar resurfacing in TKA. METHODS Databases were searched for RCTs comparing the outcomes of patellar resurfacing and nonresurfacing in TKA. Outcomes of knee relevant indicators were analysed. To see the short- and long-term effects, we calculated the data in total and divided the patients who were followed up for ≤ 3 years and ≥ 5 years into two subgroups as well. RESULTS Thirty-two trials assessing 6887 knees were eligible. There was a significant difference in terms of reoperation (in total and ≥ 5 years), Knee Society Score (KSS), function score (in total and ≥ 5 years) and noise. While no significant difference was found in the following items: reoperation (≤ 3 years), anterior knee pain (AKP), function score (≤ 3 years), range of motion (ROM), Oxford score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analogue score (VAS), Feller score, patellar tilt and the patients' satisfaction. CONCLUSIONS We found that patellar resurfacing could reduce the occurrence of reoperation and noise after surgery, as well as increase the KSS and function score, while it might not influence the outcomes such as AKP, ROM, Oxford score, KOOS, VAS, Feller score, patellar tilt and the patients' satisfaction. The results are different from our previous finding in the meta-analysis. In conclusion, we prefer patellar resurfacing in TKA.
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Affiliation(s)
- Kai Chen
- Department of Orthopedic Surgery, Hai'an People's Hospital, Zhongba Road 17, Hai'an, Nantong, 226600, Jiangsu, People's Republic of China
| | - Xiaoyu Dai
- Department of Orthopedic Surgery, The First People's Hospital of Changzhou Affiliated to Soochow University, Juqian Road 185, Changzhou, 213000, Jiangsu, People's Republic of China
| | - Lidong Li
- Department of Orthopedic Surgery, Hai'an People's Hospital, Zhongba Road 17, Hai'an, Nantong, 226600, Jiangsu, People's Republic of China
| | - Zhigang Chen
- Department of Orthopedic Surgery, Hai'an People's Hospital, Zhongba Road 17, Hai'an, Nantong, 226600, Jiangsu, People's Republic of China
| | - Haidong Cui
- Department of Orthopedic Surgery, Hai'an People's Hospital, Zhongba Road 17, Hai'an, Nantong, 226600, Jiangsu, People's Republic of China
| | - Shujun Lv
- Department of Orthopedic Surgery, Hai'an People's Hospital, Zhongba Road 17, Hai'an, Nantong, 226600, Jiangsu, People's Republic of China.
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Rassir R, Sierevelt IN, van Steenbergen LN, Nolte PA. Is obesity associated with short-term revision after total knee arthroplasty? An analysis of 121,819 primary procedures from the Dutch Arthroplasty Register. Knee 2020; 27:1899-906. [PMID: 33220579 DOI: 10.1016/j.knee.2020.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/07/2020] [Accepted: 09/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The prevalence of obesity is increasing. The association with knee osteoarthritis is well documented, resulting in the population requesting total knee arthroplasty (TKA) for invalidating symptoms to be heavier in nature. The purpose of the current analysis was to assess the association between preoperative body mass index (BMI) and short-term revision rate after TKA. The secondary aim was to investigate the influence of implant fixation method on the association between BMI and survivorship. METHODS This is a retrospective analysis of prospectively collected registry data (Dutch Arthroplasty Register; LROI). All primary TKA procedures in patients >18 years of age with registered BMI were selected (n = 121,819). Non-obese patients (BMI 18-25) were compared with overweight (BMI 25-30) and class I-III obese (BMI >30, >35, >40) patients. Crude all-cause revision rates were calculated using competing risk analysis. Adjusted hazard ratios (HRs) were determined with Cox multivariable regression analyses for all-cause, septic and aseptic revision and secondary patellar resurfacing. RESULTS Revision rates were 3.3% for non-obese patients, 3.5% for overweight patients, 3.7% for class I obese patients, 3.6% for class II obese patients and 3.7% for class III obese patients. Class III obese patients had a significant higher risk for septic revision compared with non-obese patients (HR 1.53, 95% confidence interval (CI) 1.06-2.22). Class I obese patients had a higher risk for secondary patellar resurfacing (HR 1.52, 95% CI 1.12-2.08). All-cause and aseptic revision rates were similar between BMI groups. CONCLUSIONS Obesity appeared to be associated with some short-term revision risks after TKA, but was not associated with an overall increase in revision rate.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Thilak J, Mohan V. Long-Term Comparison Study of Patella Resurfacing Versus Non-resurfacing in Total Knee Arthroplasty with Minimum 10-Year Follow-Up. Indian J Orthop 2020; 54:631-8. [PMID: 32850027 DOI: 10.1007/s43465-020-00165-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Butnaru M, Sigonney G, Müller JH, Senioris A, Saffarini M, Courage O. Wiberg Type III patellae and J-sign during extension compromise outcomes of total knee arthroplasty without patellar resurfacing. Knee 2020; 27:787-794. [PMID: 32563437 DOI: 10.1016/j.knee.2020.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/20/2020] [Accepted: 04/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Understanding the risk factors associated with postoperative pain and worse outcome can guide surgeons on whether primary patellar resurfacing is warranted during total knee arthroplasty (TKA). The purpose of this study was to determine whether clinical scores and pain after TKA without patellar resurfacing are correlated with patellar shape and postoperative patellar position and kinematics. METHODS Radiographs as well as anterior knee pain according to the Visual Analogue Scale (pVAS) were collected pre- and postoperatively for 100 knees aged 68 ± 7.7 years that received uncemented TKA without patellar resurfacing. At a minimum follow-up of 12 months the Forgotten Joint Score (FJS), the Oxford Knee Score (OKS) as well as the flexion range of motion and the presence of J-sign during active extension were recorded. Uni- and multivariable linear regression analyses were performed to determine associations between the collected clinical scores and patient demographic and radiographic data. RESULTS Postoperative OKS (79 ± 14.4) was worse for Wiberg Type III patellae (β = -11.4, P = .020, compared with Type II). Anterior pVAS (2 ± 2) was greater in knees with J-sign during extension (β = 2.8, P < .001). None of the other radiographic measurements (patellar tilt, congruence angle and lateral patellar displacement) were correlated with postoperative OKS or anterior pVAS. CONCLUSION Incongruent patellar shape (Wiberg Type III) is associated with worse clinical scores, and abnormal kinematics (J-sign) with increased pain after TKA without patellar resurfacing. The authors therefore recommend routine resurfacing for Wiberg Type III patellae, though further studies are required to confirm whether resurfacing truly improves clinical scores and pain in this subgroup.
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Affiliation(s)
- Michaël Butnaru
- Ramsay Santé, Hôpital Privé de l'Estuaire, Le Havre, France; Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
| | | | | | - Antoine Senioris
- Ramsay Santé, Hôpital Privé de l'Estuaire, Le Havre, France; Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
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Parke EA, Nakasone CK, Andrews SN, Wright AR, Stickley CD. The effect of patellar thickness on gait biomechanics following total knee arthroplasty. Knee 2019; 26:1354-9. [PMID: 31780198 DOI: 10.1016/j.knee.2019.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 09/04/2019] [Accepted: 09/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patella resurfacing is commonly performed during total knee arthroplasty; however, determining the appropriate patellar thickness remains a challenge. The purpose of this study was to evaluate the role of post-TKA patellar thickness on knee extensor strength and biomechanical joint loading forces during walking and stair negotiation. METHODS Fifteen patients (21 knees) underwent gait analysis prior to TKA and post-TKA at six weeks, three months, six months, and one year. Knee extensor strength and biomechanics were collected during level walking and stair negotiation and analyzed using Pearson correlation coefficients. RESULTS Knee extensor strength was positively correlated to patellar thickness at three months and one year post-TKA (p ≤ .05). During walking, no significant correlations were present. During stair ascent, there was a positive correlation between patellar thickness and peak knee flexion angle one year post-TKA (p ≤ .05). During stair descent, there was a positive correlation between patellar thickness and maximum vertical ground reaction forces at one year post-TKA (p ≤ .01). CONCLUSIONS The loss of patellar thickness when compared to measured pre-resurfacing thickness was correlated with a decrease in knee extensor strength; however, changes in patellar thickness were not significantly correlated to biomechanical loading forces during walking. Increases in demand of activity increase the torque to the knee joint, which elicit increases in compensatory motions, likely reducing the extent to which differences in joint loading during stair negotiation may be attributable to changes in patellar thickness. Therefore, the effect of post-patellar thickness on patient function in primary TKA is limited.
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Pehlivanoglu T, Balci HI, Demirel M, Cakmak MF, Yazicioglu O, Kilicoglu OI. Prevalence of anterior knee pain after patellar retention total knee arthroplasty: Comparison of patients with rheumatoid arthritis versus primary osteoarthritis. Acta Orthop Traumatol Turc 2019; 53:420-425. [PMID: 31445793 PMCID: PMC6939004 DOI: 10.1016/j.aott.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/06/2019] [Accepted: 07/08/2019] [Indexed: 11/18/2022]
Abstract
Objective The aim of this study was to investigate whether there is an increased risk of anterior knee pain (AKP) after total knee arthroplasty (TKA) without patellar resurfacing in patients with rheumatoid arthritis (RA) versus primary osteoarthritis (OA). Methods This study was a retrospective review of 388 patients (577 knees) who underwent TKA without patellar resurfacing between 2003 and 2011, with a minimum of 5 years of follow-up. Patients were divided into two groups: Group OA (273 knees of 206 patients; 83 males, 123 females; mean age: 64.4 (47–87) years) and Group RA (304 knees of 182 patients; 92 males, 90 females; mean age: 50.7 (21–72) years). In the clinical evaluation, the knee range of motion (ROM) and several outcome measures such as The Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and International Knee Documentation Committee (IKDC) scores were used preoperatively and at the final follow-up visit. The quality of life was measured using Short Form (SF)-36 MCS and PCS scores. The primary outcome was the frequency and severity of patient-reported AKP. The AKP Scale was used to determine the severity of AKP. Results The IKDC raised from 21.62 (range, 13–29.9) preoperatively to 85.1 (range, 80–88) for group OA and from 21.8 (range, 13–29.9) to 85.2 (range, 81–88) for group RA (p < 0.001). The mean KSS improved from 28.35 (range, 22–38) preoperatively to 90.04 (range, 88–95) for group OA and from 21.9 (range, 18–35) preoperatively to 89.7 (range, 86–95) for group RA. The mean WOMAC increased from 20.61 (range, 17.4–24.2) preoperatively to 95.7 (range, 90.9–97.7) for group OA (p < 0.001) and from 20.2 (range, 16.7–24.2) preoperatively to 95.8 (range, 90.9–98.5) for group RA (p < 0.001). The mean ROM improved from 80.14° (range, 55°–130°) preoperatively to 113.17° (range, 95°–140°) in group OA (P = 0.003) and from 73.4° (range, 10°–130°) to 112.8° (range 90°–140°) in group RA (P = 0.003) postoperatively. The frequency of AKP was 8% in Group OA and 7% in Group RA (p = 0.27). For patients with AKP, the mean AKP Scale was 92.74 (range, 84–98) in Group OA and 93.39 (range, 82–98) in Group RA (p = 0.3). Conclusion After TKA without resurfacing the patella, patients with RA were determined to have a similar risk for AKP as those with OA. Level of evidence Level III, Therapeutic Study.
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MESH Headings
- Aged
- Aged, 80 and over
- Arthralgia/epidemiology
- Arthralgia/etiology
- Arthralgia/physiopathology
- Arthritis, Rheumatoid/physiopathology
- Arthritis, Rheumatoid/surgery
- Arthroplasty, Replacement, Knee/adverse effects
- Female
- Humans
- Knee Joint/diagnostic imaging
- Knee Joint/physiopathology
- Knee Joint/surgery
- Male
- Middle Aged
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/surgery
- Pain, Postoperative/epidemiology
- Pain, Postoperative/etiology
- Patella/surgery
- Prevalence
- Range of Motion, Articular
- Retrospective Studies
- Treatment Outcome
- Turkey/epidemiology
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Affiliation(s)
- Tuna Pehlivanoglu
- Department of Orthopaedics and Traumatology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.
| | - Halil Ibrahim Balci
- Department of Orthopaedics and Traumatology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.
| | - Mehmet Demirel
- Department of Orthopaedics and Traumatology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.
| | - Mehmet Fevzi Cakmak
- Department of Orthopaedics and Traumatology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.
| | - Onder Yazicioglu
- Department of Orthopaedics and Traumatology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.
| | - Onder Ismet Kilicoglu
- Department of Orthopaedics and Traumatology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.
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Christopher ZK, Deckey DG, Chung AS, Spangehl MJ. Patellar osteolysis after total knee arthroplasty with patellar resurfacing: a potentially underappreciated problem. Arthroplast Today 2019; 5:435-441. [PMID: 31886386 PMCID: PMC6921183 DOI: 10.1016/j.artd.2019.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 09/02/2019] [Accepted: 09/17/2019] [Indexed: 11/30/2022] Open
Abstract
Osteolysis of the patella following total knee arthroplasty is both uncommon and poorly described in the literature. We describe 3 cases of total knee arthroplasty with patella resurfacing that later presented with anterior knee pain with patellar osteolysis without evidence of patellar implant failure: 2 males and 1 female patient, all with bilateral knee osteoarthritis. Osteolysis of the patella was identified radiographically between 2 and 16 years from the index procedure. We theorize that high pressures across the patella-femoral joint, in obese or muscular patients, may play a role in the formation of these patellar osteolytic lesions. We suspect that the prevalence of this phenomenon is under-recognized in the literature and may increase with longer term follow-up and awareness.
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Affiliation(s)
| | | | | | - Mark J. Spangehl
- Corresponding author. Department of Orthopedics, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA. Tel.: +1 480 342 6202.
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Belvedere C, Ensini A, Tamarri S, d'Amato M, Barbadoro P, Feliciangeli A, Rao A, Leardini A. Does navigated patellar resurfacing in total knee arthroplasty result in proper bone cut, motion and clinical outcomes? Clin Biomech (Bristol, Avon) 2019; 69:168-77. [PMID: 31369961 DOI: 10.1016/j.clinbiomech.2019.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/18/2019] [Accepted: 07/23/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND In total knee arthroplasty with patellar resurfacing, patellar bone preparation, component positioning and motion assessments are still not navigated. Only femoral/tibial component positioning is supported by computer-assistance. The aim of this study was to verify, in-vivo, whether knee surgical navigation extended to patellar resurfacing, by original instrumentation and procedures for patellar-based tracking, could achieve accurate patella preparation in terms of original thickness restoration, bone cut orientation, and normal knee motion. METHODS An additional navigation system for patellar data acquisition was used together with a standard navigation system for total knee arthroplasty in 20 patients. This supported the surgeon for patellar resurfacing via measurement of removed bone thickness, three-dimensional patellar cut orientations, and patello-femoral motion. Radiological and clinical examinations at 6 and 24-month follow-up were also performed. FINDINGS The medio-lateral patellar-bone cut orientation was respectively 0.5° (standard deviation: 3.0°) and 1.4° (1.7°) lateral tilt, as measured via navigation and post-operatively on the Merchant x-ray view. The cranio-caudal orientation was 3.8° (7.2°) of flexion. The thickness variation between patellar pre- and post-implantation was 0.2 (1.3) mm. Immediately after implantation, patello-femoral as well as tibio-femoral kinematics was within the normality. Good radiological and clinical examinations at 6 and 24-month follow-up were also observed. INTERPRETATION For the first time, the effect of patellar navigation for its resurfacing was assessed in-vivo during surgery, with very good results for thickness restoration, proper cut orientation, and normal knee motion. These results support the introduction of patella-related navigation-based surgical procedures for computer-assisted total knee arthroplasty.
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Migliorini F, Eschweiler J, Niewiera M, El Mansy Y, Tingart M, Rath B. Better outcomes with patellar resurfacing during primary total knee arthroplasty: a meta-analysis study. Arch Orthop Trauma Surg 2019; 139:1445-1454. [PMID: 31367842 DOI: 10.1007/s00402-019-03246-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a feasible and cost-effective procedure. However, resurfacing of the patella sparks a heated debate. Anterior knee pain after TKA was supposed to be correlated to the patellofemoral joint, and the resurface of the patella was believed to be effective to avoid this complication. AIM A meta-analysis was performed to update current evidence concerning the outcomes of patellar resurfacing versus retaining for total knee arthroplasty. The first outcomes of interest were to compare the rate of anterior knee pain and revision surgeries. MATERIAL AND METHODS This study was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). A comprehensive review of the literature was conducted accessing the main databases: Embase, Google Scholar, PubMed, Scopus. All the prospective clinical trials comparing the outcomes between patellar resurfacing versus retaining were included in this study. Only articles classified as level of evidence I to II were considered for inclusion. Only studies reporting a minimum 24 months follow-up were included. The following data were extracted: demographic baseline, anterior knee pain, reoperations, clinical scores (HSS, KSS and related subscales) and range of motion (ROM). Studies solely reporting quantitative data under the outcomes of interest were included. RESULTS In favor of the resurfacing group, we observed a statistically significant reduced rate of anterior knee pain (odd ratio 1.73) and reoperation (odd ratio 3.24). In the resurfacing group, a prevalence of anterior knee pain of 11.15% was detected, whereas in the retaining group it amounted to 17.39%. Furthermore, a greater KSS pain (+ 0.97%), KSS clinical (+ 0.23%), KSS functional (+ 2.44%), KSS overall (+ 2.47%) and HSS (+ 5.64%) were reported. In the retaining group, we found a better range of motion (+ 3.09°). CONCLUSION Based on the main findings of this meta-analysis, patellar resurfaced TKA was demonstrated to have performed superior overall. Patellar resurfacing detected a lower rate of postoperative anterior knee pain and reoperation. Moreover, the resurfacing group showed greater value of the HSS, KSS and related subscales. In favor of the retaining group, a slightly better ROM was evidenced. LEVEL OF EVIDENCE Level II, meta-analysis of prospective clinical trials.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Marc Niewiera
- Department of General Surgery, Eifelklinik St. Brigida, Simmerath, Germany
| | - Yasser El Mansy
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.,Department of Orthopaedics and Traumatology, Alexandria University, Alexandria, Egypt
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Björn Rath
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
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Kaseb MH, Mortazavi J, Ayati Firoozabadi M, Toofan H. Comparison between Patellar Resurfacing and Retention in Total Knee Arthroplasty Regarding the Postoperative Satisfaction of Patients and Patellar Crepitus. Arch Bone Jt Surg 2019; 7:441-444. [PMID: 31742221 PMCID: PMC6802549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 10/10/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND Patellar crepitus after total knee arthroplasty (TKA) is not uncommon. The choice between patellar resurfacing or retention in TKA has remained controversial. Therefore, this randomized controlled trial aimed to evaluate the impact of patellar resurfacing on the incidence of patellar crepitus. In addition, we compared the clinical outcomes and satisfaction between the patients who underwent patellar retention or resurfacing. METHODS A total of 63 patients randomly received patellar resurfacing or non-resurfacing TKA by one surgeon at Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran during May 2014-February 2017. Finally, 29 patients in the resurfaced group and 44 subjects with retained patella were evaluated pre-op and in an average follow-up period of 8.68 months using the clinical Knee Society Score (KSS), functional KSS, and Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS Our findings demonstrated no significant difference between the two groups regarding the satisfaction of patients, KSS, and KOOS. It was shown that the latter scores improved in both groups in the follow-up period. Nonetheless, patellar crepitus was not statistically different between the two groups. CONCLUSION According to the results of the present study, patellar resurfacing did not lead to decreased patellar crepitus or enhanced clinical outcomes of TKA.
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Affiliation(s)
- Mohammad H Kaseb
- Tehran University of Medical Sciences, Tehran, Iran
- Imam khomeini hospital complex orthopedic surgury department, medical faculty, tehran univercity, iran
- Research performed at Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Mortazavi
- Tehran University of Medical Sciences, Tehran, Iran
- Imam khomeini hospital complex orthopedic surgury department, medical faculty, tehran univercity, iran
- Research performed at Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ayati Firoozabadi
- Tehran University of Medical Sciences, Tehran, Iran
- Imam khomeini hospital complex orthopedic surgury department, medical faculty, tehran univercity, iran
- Research performed at Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hesam Toofan
- Tehran University of Medical Sciences, Tehran, Iran
- Imam khomeini hospital complex orthopedic surgury department, medical faculty, tehran univercity, iran
- Research performed at Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Ha C, Wang B, Li W, Sun K, Wang D, Li Q. Resurfacing versus not-resurfacing the patella in one-stage bilateral total knee arthroplasty: a prospective randomized clinical trial. Int Orthop 2019; 43:2519-2527. [PMID: 31227852 PMCID: PMC6848038 DOI: 10.1007/s00264-019-04361-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 06/12/2019] [Indexed: 12/20/2022]
Abstract
Purpose Resurfacing the patella in one-stage bilateral total knee arthroplasty (TKA) remains debatable. This study aimed to assess the mid-term outcomes of patients after one-stage bilateral TKA performed with and without patellar resurfacing, respectively, with at least five years of follow-up. Methods Sixty-six patients (132 knees) scheduled for first-ever one-stage bilateral TKA due to osteoarthritis received patellar resurfacing and retention, respectively, on one knee and the other, randomly selected. All patients received Scorpio NRG knee prostheses and were evaluated by radiology (anteroposterior, lateral, and axial views) pre-operatively and yearly post-operatively, for at least five years. Knee Society Score and Feller Score values were measured. Anterior knee pain, patellar clunk, and patient satisfaction were assessed. Results One patient died within five years of operation and four were lost to follow-up. One patient developed severe dementia and could not be constructively questioned. Therefore, 60 patients (120 knees) were finally analyzed. There were significantly improved Knee Society and Feller scores (P < 0.001) in the resurfacing group compared with the non-resurfacing group post-operatively. Anterior knee pain and patellar clunk rates were lower on the resurfaced side compared with the non-resurfaced side (P < 0.001). Meanwhile, 47% and only 7% patients preferred the resurfaced and non-resurfaced sides, respectively, at final follow-up. No revision was performed for patellofemoral complications, and no significant differences were found between the two groups in radiographic outcomes. Conclusions Using the Scorpio NRG knee prosthesis, patellar resurfacing is superior to non-resurfacing in patients with osteoarthritis observed for ≥ five years. Registration trials number NCT03600922 Key Points • Findings Patellar resurfacing is superior to non-resurfacing in osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA) with the Scorpio NRG knee prosthesis. • Implications Patellar resurfacing should be performed in OA patients during TKA. • Caution Several prosthesis types should be assessed in the same study setting, and multicenter studies are required before generalizability of the present findings. Electronic supplementary material The online version of this article (10.1007/s00264-019-04361-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chengzhi Ha
- Department of Joint Surgery, Liaocheng People's Hospital, Liaocheng, 252000, ShanDong, China
| | - Baoxin Wang
- Department of Joint Surgery, Liaocheng People's Hospital, Liaocheng, 252000, ShanDong, China
| | - Wei Li
- Department of Joint Surgery, Liaocheng People's Hospital, Liaocheng, 252000, ShanDong, China
| | - Kang Sun
- Department of Joint Surgery, Affiliated Hospital of Qingdao University, No. 1677 Wutai mountain Road, Economic Development Zone, Qingdao, 266071, Shandong, China
| | - Dawei Wang
- Department of Joint Surgery, Liaocheng People's Hospital, Liaocheng, 252000, ShanDong, China.
| | - Qicai Li
- Department of Joint Surgery, Affiliated Hospital of Qingdao University, No. 1677 Wutai mountain Road, Economic Development Zone, Qingdao, 266071, Shandong, China.
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Koh IJ, Kim MS, Sohn S, Song KY, Choi NY, In Y. Patients undergoing total knee arthroplasty using a contemporary patella-friendly implant are unaware of any differences due to patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2019; 27:1156-64. [PMID: 30132051 DOI: 10.1007/s00167-018-5120-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 08/14/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Anterior knee pain after total knee arthroplasty (TKA) is often unexplained, spurring ongoing debates on the need for patellar resurfacing. It was hypothesized that a contemporary patella-friendly implant would restore patellofemoral kinematics more physiologically than outdated implants and that there would be no perceived or clinically demonstrable differences due to resurfacing of patella (RP). METHODS This prospective bilateral randomized study was undertaken in 49 patients scheduled for the same-day bilateral TKAs. One knee was subjected at random to RP while withholding RP on the opposing side (non-RP). A recently approved single-radius femoral prosthesis featuring a deep, elongate trochlear groove with lateral tilt and a high lateral flange was implanted bilaterally in all patients. Mean follow-up duration was 5 years. Group comparisons were based on patient-reported outcomes [anterior knee pain, Forgotten Joint Score (FJS), and side preference], physician-rated results [Feller patellofemoral (PF) score], radiographic patellar position, patella-related complications, and need for reoperation. RESULTS There were no differences in midterm rates of anterior knee pain (RP 8%; non-RP 4%; n.s.), FJS (all n.s.), or side preference (RP 47%; non-RP 45%; n.s.), nor did the groups differ by Feller PF score (all n.s.) or radiographic patellar position (all n.s.). No secondary resurfacings of non-RP or RP revisions were required. CONCLUSIONS Patients were incapable of distinguishing whether RP was done, casting doubt on its benefits. Surgeons may thus forego RP during TKA when using contemporary patella-friendly TKA implants. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Grassi A, Compagnoni R, Ferrua P, Zaffagnini S, Berruto M, Samuelsson K, Svantesson E, Randelli P. Patellar resurfacing versus patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses. Knee Surg Sports Traumatol Arthrosc 2018; 26:3206-18. [PMID: 29335747 DOI: 10.1007/s00167-018-4831-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/02/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE The need of patellar resurfacing in total knee arthroplasty (TKA) is a subject of debate. This systematic review of overlapping meta-analyses aimed to assess and analyze current evidence regarding patellar resurfacing and non-resurfacing in TKA. METHODS A systematic literature search was performed in March 2017 in PubMed, CINAHL and Cochrane Library. Inclusion criteria were meta-analysis of randomized controlled trials that compared TKA with and without patellar resurfacing considering as outcomes re-operations rate, complications, anterior knee pain, functional scores. The quality of meta-analyses was evaluated with AMSTAR score and the most relevant meta-analysis was determined by applying the Jadad algorithm. RESULTS Ten meta-analyses, published between 2005 and 2015, were included in the systematic review. Two studies found a significantly increased Knee Society Score in the resurfacing group. According to four meta-analyses, anterior knee pain incidence was lower in resurfacing group. Six of the included studies described a greater risk of re-intervention in the non-resurfacing groups. The overall quality of included studies was moderate. The most relevant meta-analysis reported no differences in functional scores and incidence of anterior knee pain between the groups. CONCLUSIONS Comparable outcomes were found when comparing patellar resurfacing and non-resurfacing in TKA. The higher risk of re-operations after non-resurfacing should be interpreted with caution due to the methodological limitations of the meta-analyses regarding search criteria, heterogeneity and the inherent bias of easier indication to reoperation when the patella is not resurfaced. There is no clear superiority of patellar resurfacing compared to patellar retention. LEVEL OF EVIDENCE Level II, systematic review of meta-analyses.
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Slevin O, Schmid FA, Schiapparelli F, Rasch H, Hirschmann MT. Increased in vivo patellofemoral loading after total knee arthroplasty in resurfaced patellae. Knee Surg Sports Traumatol Arthrosc 2018; 26:1805-1810. [PMID: 29188334 DOI: 10.1007/s00167-017-4803-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/10/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The primary purpose of the study was to investigate if and how patellar bone tracer uptake (BTU) distribution in SPECT/CT is influenced by patellar resurfacing and the position of femoral and tibial TKA component position. METHODS A total of 104 knees of 103 consecutive patients who underwent primary TKA were prospectively investigated. Primary patellar resurfacing was done in 40 knees while 64 had a TKA without patellar resurfacing. All patients underwent clinical assessment using the knee society score (KSS) and standardized radiographs and Tc-99m-HDP-SPECT/CT before and 12 and 24 months after TKA. Measurements of BTU including intensity and anatomical distribution pattern in eight different patellar regions were performed. Tibial and femoral TKA component position was assessed from 3D reconstructed CT data. Patellar height, thickness and tilt were measured and the distance between the tibial tuberosity and the trochlear groove (TT-TG) was measured. Univariate analysis was performed to identify differences between the two groups (p < 0.05). RESULTS Significantly higher BTU was found in the anterior, non-articular, areas of the patella in patients who underwent patellar resurfacing (p < 0.05). The BTU pattern was similar between the groups, as the maximal uptake in both groups was seen in the superior posterior parts and the minimal uptake was seen in the inferior anterior parts. The mean postoperative KSS was significantly higher in the unresurfaced group after 12 months (p < 0.05), but with no significant difference after 24 months. CONCLUSIONS Based on the findings of the present study, patellar resurfacing is related to significantly higher BTU in the anterior parts of the patella and lower clinical outcomes. In light of these results, routine patellar resurfacing as part of a primary TKA might be reevaluated. SPECT/CT enables a precise localization of the BTU and might be considered as the ideal imaging modality for evaluation and investigate of patellofemoral disorders after TKA.
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Affiliation(s)
- Omer Slevin
- Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel.,Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland
| | - Florian A Schmid
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
| | - Filippo Schiapparelli
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
| | - Helmut Rasch
- Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland. .,University of Basel, Basel, Switzerland.
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Kaseb MH, Tahmasebi MN, Mortazavi SJ, Sobhan MR, Nabian MH. Comparison of Clinical Results between Patellar Resurfacing and Non-resurfacing in Total Knee Arthroplasty: A Short Term Evaluation. Arch Bone Jt Surg 2018; 6:124-129. [PMID: 29600265 PMCID: PMC5867356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 01/13/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND There is no difference in the functional outcomes 6 months after total knee arthroplasty (TKA) for knee osteoarthritis between patellar resurfacing and non-resurfacing. Thus, we have performed this study to compare the short-term clinical outcomes of TKA performed with and without the patella resurfacing. METHODS A total of 50 patients with osteoarthritis of the knee (OAK) were randomized to receive patellar resurfacing (n=24; resurfaced group) or to retain their native patella (n=26; non-resurfaced group) based on envelope selection and provided informed consent. Disease specific outcomes including Knee Society Score (KSS), Knee Society Function Score (KSKS-F), Kujala Anterior Knee Pain Scale (AKPS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Short Form 36 (SF-36), and functional patella-related activities were measured within six months of follow-up. RESULTS There was no significant difference between the resurfaced and non-resurfaced groups in pre and post-operative improvement of range of motion (ROM) (P=0.421), KSS (P=0.782, P=0.553), KSKS-F (P=0.241, P=0.293), AKPS (P=0.128, P=0.443), WOMAC (P=0.700, P=0.282), and pain scores (P=0.120, P=0.508). There was no difference in ROM between resurfaced and non-resurfaced group pre (15.24° and 15.45°) and post-operative (18.48° and 18.74). No side effects related to patella was observed in any of the groups. Revision was required in none of the participants. CONCLUSION The results showed no significant difference between patellar resurfacing and non-resurfacing in TKA for all outcome measures in a short term.Level of evidence: I.
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Affiliation(s)
- Mohammad H Kaseb
- Department of Orthopedic Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad N Tahmasebi
- Department of Orthopedic Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sm Javad Mortazavi
- Department of Orthopedic Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad R Sobhan
- Department of Orthopedic Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad H Nabian
- Department of Orthopedic Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Belvedere C, Ensini A, d'Amato M, Barbadoro P, Leardini A. Three-dimensional patellar tendon fibre kinematics in navigated TKA with and without patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2017; 25:3834-3843. [PMID: 27738741 DOI: 10.1007/s00167-016-4343-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/23/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE Physiological elongation and orientation of patellar tendon fibres are among the scopes of total knee arthroplasty, but little is known in the three dimensions. The study aims to assess in vitro these variations at the intact and replaced knee, with and without patellar resurfacing. It was hypothesised that fibre patterns differ before and after prosthesis implantation, and between specific prosthesis designs. It was also expected that patellar resurfacing would affect relevant results. METHODS Measurements from 16 intact cadaver knees free from anatomical defects are here reported using a surgical navigation system. Data were collected at the intact joint and after implantation with cruciate-retaining or posterior-stabilised prosthesis designs, with and without patellar resurfacing. Relevant anatomical landmarks and patellar tendon attachments were digitised. Anatomical reference frames in the femur, tibia and patella were defined to measure component implantation parameters. Representative tendon fibres were defined as the straight line segments joining the two extremities. Changes in length and orientation of these fibres were calculated and reported versus flexion at the intact knee and after prosthesis implantation, both with and without patellar resurfacing. RESULTS A good intra- and inter-specimen repeatability was found at the intact and replaced knees. In both prosthesis designs, the patterns of fibre lengthening were similar to those in the intact knee, though significant differences were observed before and after patellar resurfacing. Corresponding fibre orientations in the frontal and sagittal planes showed significantly smaller ranges than those in the corresponding intact joints. More natural patterns were observed in the knees implanted with the posterior-stabilised design. Significant correlations were identified between patellar component implantation parameters and both patellar tendon fibre elongation and orientation. CONCLUSIONS Differences, however small, in patellar tendon fibre elongation and orientation were observed after total knee arthroplasty. The posterior-stabilised design provided better results, whereas patellar resurfacing affected significantly normal patellar function. In the clinical practice, the present findings can contribute to the understanding of current prosthesis designs and patellar resurfacing, recommending also enhanced care during this surgery.
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Affiliation(s)
- C Belvedere
- Movement Analysis Laboratory and Functional - Clinical Evaluation of Prostheses, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - A Ensini
- Movement Analysis Laboratory and Functional - Clinical Evaluation of Prostheses, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.,2nd Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M d'Amato
- 2nd Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - P Barbadoro
- 2nd Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Leardini
- Movement Analysis Laboratory and Functional - Clinical Evaluation of Prostheses, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
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Werth L, Saffarini M, Amsler F, Abdelkafy A, Hirschmann MT. The need for secondary resurfacing is affected by trochlear height in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:3818-23. [PMID: 27624180 DOI: 10.1007/s00167-016-4319-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 09/02/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of the study was to compare the rate of secondary resurfacing in a consecutive series of five different total knee arthroplasty (TKA) systems. It was our hypothesis that different TKA design features such as sulcus angle or trochlear height influence the rate of secondary resurfacing. METHODS A retrospective study was performed on data from patients who underwent TKA without primary patellar resurfacing from 2004 to 2012 in an university-affiliated hospital. The study cohort included 784 TKA patients (m:f = 302:482, mean age at surgery ± SD 71 ± 10). Five different cruciate-retaining TKA systems were used consecutively (Group A, Triathlon, Stryker, Switzerland (n = 296), Group B, PFC Sigma, DepuySynthes, Switzerland (n = 215), Group C, LCS, DepuySynthes, Switzerland (n = 81), Group D, Balansys, Mathys, Switzerland (n = 128), Group E, Duracon, Stryker, Switzerland (n = 64)). Data were retrospectively obtained from hospital archives. Patients demographics, age at surgery, type of TKA were noted. In addition, TKA component position was assessed on radiographs with respect to "The knee society total knee arthroplasty roentgenographic evaluation and scoring system" (TKA-RESS). Pearson Chi-square test was used to compare differences between groups (p < 0.05). There were no significant differences between the groups in terms of age, gender, and radiological outcomes. RESULTS Twenty-six of 784 patients (3.3 %) underwent secondary resurfacing due to patellofemoral pain. In group A 4/296 patients (1.4 %), in group B 15/215 patients (7 %), in group C 5/81 patients (6.2 %), in group D 1/128 patients (0.8 %), in group E 1/64 patients (1.6 %) underwent secondary patellar resurfacing during follow-up. Significantly higher rates of secondary patellar resurfacing were seen in groups B and C when compared to the others (p < 0.001). It was found that the trochlear height in these TKA was higher than in the others. CONCLUSIONS Based on the findings of this study, trochlear height influences the need for secondary patellar resurfacing. The resurfacing rate ranged from 1 to 7 %, with the highest rate in the PFC Sigma TKA. LEVEL OF EVIDENCE Therapeutic study, Level III.
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Chun KC, Lee SH, Baik JS, Kook SH, Han JK, Chun CH. Clinical and radiological results of cruciate-retaining total knee arthroplasty with the NexGen®-CR system: comparison of patellar resurfacing versus retention with more than 14 years of follow-up. J Orthop Surg Res 2017; 12:144. [PMID: 28969683 PMCID: PMC5625661 DOI: 10.1186/s13018-017-0646-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study is to analyze clinical and radiological outcomes of patients (with a minimum of 14 years of follow-up) who underwent cruciate-retaining (CR) total knee arthroplasty (TKA) using a NexGen®-CR, comparing a patellar resurfacing group with a patellar retention group. METHODS From June 1996 to April 2002, 116 cases of TKA using a NexGen®-CR who had at least 14 years of follow-up were enrolled in this study. Among them, 68 cases had patellar resurfacing and 48 had patellar retention. The average follow-up period was 14.8 years (14.1-18.7). Clinical scores and range of motion (ROM) were evaluated preoperatively and at the last follow-up in all patients. The Hospital for Special Surgery (HSS) score, Knee Society Score (KSS), Western Ontario and MacMaster Universities Osteoarthritis (WOMAC) score, and a new patellar score were assessed. Radiological evaluations are done by analyzing the tibiofemoral angle, loosening, and a radiolucent line on the radiograph by American Knee Society Roentgen Graphic Evaluation. RESULTS The average HSS score of both the patellar resurfacing group and retention group increased from 42.3 and 41.2 preoperatively to 90.2 and 90.8 at the last follow-up, respectively. The KSS, WOMAC score, patellar score, and knee joint ROM also improved significantly in both groups. However, there were no significant differences in clinical results between the two groups. On the radiological evaluation, the tibiofemoral angle in both groups had improved from varus 7.8° and 7.2° preoperative to valgus 4.9° and 4.8°, respectively. The average angles of α, β, γ, and δ were 94.1°, 90.4°, 3.2°, and 87.8° in the patellar resurfacing group and 94.4°, 89.8°, 3.3°, and 88.1° in the patellar retention group, respectively. A radiolucent line shown on radiograph was noted in a total of seven cases, three in the patellar resurfacing group and four in the patellar retention group. In the patellar resurfacing group, among the seven zones on the tibia radiograph, all cases were located at the medial side of tibia and two cases were in zone 1 and one case in zone 2, and in the patellar retention group, three cases were in zone 1 and 1 case was in zone 2, also located on the same side. CONCLUSIONS We achieved satisfactory clinical and radiological outcomes on long-term follow-up when performing TKAs with a NexGen®-CR. There was no significant difference in clinical or radiological results between the patellar resurfacing and retention groups in our study.
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Affiliation(s)
- Keun Churl Chun
- Department of Orthopedic Surgery, School of Medicine, Wonkwang University, 895, Muwang-Ro, Iksan, 54538, South Korea
| | - Sung Hyun Lee
- Department of Orthopedic Surgery, School of Medicine, Wonkwang University, 895, Muwang-Ro, Iksan, 54538, South Korea
| | - Jong Seok Baik
- Department of Orthopedic Surgery, School of Medicine, Wonkwang University, 895, Muwang-Ro, Iksan, 54538, South Korea
| | - Seng Hwan Kook
- Department of Orthopedic Surgery, School of Medicine, Wonkwang University, 895, Muwang-Ro, Iksan, 54538, South Korea
| | - Joung Kyue Han
- Collage of Sports Science, Chung-Ang University, Anseong, South Korea
| | - Churl Hong Chun
- Department of Orthopedic Surgery, School of Medicine, Wonkwang University, 895, Muwang-Ro, Iksan, 54538, South Korea.
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Huang CH, Hsu LI, Chang TK, Chuang TY, Shih SL, Lu YC, Chen CS, Huang CH. Stress distribution of the patellofemoral joint in the anatomic V-shape and curved dome-shape femoral component: a comparison of resurfaced and unresurfaced patellae. Knee Surg Sports Traumatol Arthrosc 2017; 25:263-271. [PMID: 25539687 DOI: 10.1007/s00167-014-3485-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 12/11/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE Whether to resurface the patella in knee replacement remains a controversial issue. The geometrical design of the trochlear groove in the femoral component could play an important role in determining the stress distribution on the patellofemoral joint, but this has not been sufficiently reported on. This study attempted to determine the effect of implant design on contact mechanics by means of a finite element method. METHODS Two designs, an anatomical V-shape design (VSD) and a dome-shape design (DSD), for the anterior trochlear surface in a contemporary femoral component were chosen for examining the contact characteristics. The use and absence of patella resurfacing was simulated. The stress and strain distribution on the patellar bone and the polyethylene component were calculated for comparison. RESULTS Without patellar resurfacing, the maximal compressive strain in the patellar bone in the VSD model was about 20 % lower than the DSD model. On the other hand, with resurfacing, the maximal strain for the VSD model was 13.3 % greater than for DSD. Uneven stress distribution at the bone-implant interface was also noted for the two designs. CONCLUSION The femoral component with a V-shape trochlear groove reduced the compressive strain on the unresurfaced patella. If resurfacing the patella, the femoral component with a curved domed-shape design might reduce the strain in the remaining patellar bone. Uneven stress could occur at the bone-implant interface, so design modifications for improving fixation strength and medialization of the patellar button would be helpful in reducing the risk of peg fracture or loosening. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Chang-Hung Huang
- Biomechanics Research Laboratory, Mackay Memorial Hospital, No. 45, Mingsheng Rd, Tamshui District, New Taipei City, 25160, Taiwan.,Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No. 155, Sec. 2, Li-Nung St., Taipei, 112, Taiwan.,Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Lin-I Hsu
- Biomechanics Research Laboratory, Mackay Memorial Hospital, No. 45, Mingsheng Rd, Tamshui District, New Taipei City, 25160, Taiwan
| | - Ting-Kuo Chang
- Biomechanics Research Laboratory, Mackay Memorial Hospital, No. 45, Mingsheng Rd, Tamshui District, New Taipei City, 25160, Taiwan.,Department of Orthopaedic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Tai-Yuan Chuang
- Department of Orthopedic Surgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Shih-Liang Shih
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No. 155, Sec. 2, Li-Nung St., Taipei, 112, Taiwan.,Department of Orthopaedic Surgery, Zhong-Xing Branch of Taipei-City Hospital, Taipei, Taiwan
| | - Yung-Chang Lu
- Biomechanics Research Laboratory, Mackay Memorial Hospital, No. 45, Mingsheng Rd, Tamshui District, New Taipei City, 25160, Taiwan. .,Department of Orthopaedic Surgery, Mackay Memorial Hospital, Taipei, Taiwan. .,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
| | - Chen-Sheng Chen
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No. 155, Sec. 2, Li-Nung St., Taipei, 112, Taiwan.
| | - Chun-Hsiung Huang
- Biomechanics Research Laboratory, Mackay Memorial Hospital, No. 45, Mingsheng Rd, Tamshui District, New Taipei City, 25160, Taiwan.,Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
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Vandenneucker H, Labey L, Vander Sloten J, Desloovere K, Bellemans J. Isolated patellofemoral arthroplasty reproduces natural patellofemoral joint kinematics when the patella is resurfaced. Knee Surg Sports Traumatol Arthrosc 2016; 24:3668-3677. [PMID: 25381467 DOI: 10.1007/s00167-014-3415-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 10/29/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The objectives of this in vitro project were to compare the dynamic three-dimensional patellofemoral kinematics, contact forces, contact areas and contact pressures of a contemporary patellofemoral prosthetic implant with those of the native knee and to measure the influence of patellar resurfacing and patellar thickness. The hypothesis was that these designs are capable to reproduce the natural kinematics but result in higher contact pressures. METHODS Six fresh-frozen specimens were tested on a custom-made mechanical knee rig before and after prosthetic trochlear resurfacing, without and with patellar resurfacing in three different patellar thicknesses. Full three-dimensional kinematics were analysed during three different motor tasks, using infrared motion capture cameras and retroflective markers. Patellar contact characteristics were registered using a pressure measuring device. RESULTS The patellofemoral kinematic behaviour of the patellofemoral arthroplasty was similar to that of the normal knee when the patella was resurfaced, showing only significant (p < 0.0001) changes in patellar flexion. Without patellar resurfacing, significant more patellar flexion, lateral tilt and lateral rotation was noticed. Compared to the normal knee, contact pressures were significantly elevated after isolated trochlear resurfacing. However, the values were more than doubled after patellar resurfacing. Changes in patellar thickness only influenced the antero-posterior patellar position. There was no other influence on the kinematics, and only a limited influence on the contact pressures in the low flexion angles. CONCLUSION The investigated design reproduced the normal patellofemoral kinematics acceptable well when the patella was resurfaced. From a kinematic point of view, patellar resurfacing may be advisable. However, the substantially elevated patellar contact pressures remain a point of concern in the decision whether or not to resurface the patella. This study therefore not only adds a new point in the discussion whether or not to resurface the patella, but also supports the claimed advantage that a patellofemoral arthroplasty is capable to reproduce the natural knee kinematics.
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Affiliation(s)
- Hilde Vandenneucker
- Department of Development and Regeneration - Orthopaedic Surgery, University Hospitals Leuven, Weligerveld 1, 3212, Pellenberg-Lubbeek, Belgium.
| | - Luc Labey
- European Centre for Knee Research, Smith&Nephew, Technologielaan 11 bis, 3000, Leuven, Belgium
| | - Jos Vander Sloten
- Biomechanics Section, University of Leuven, Celestijnenlaan 300c, 3000, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg-Lubbeek, Belgium
| | - Johan Bellemans
- Department of Development and Regeneration - Orthopaedic Surgery, University Hospitals Leuven, Weligerveld 1, 3212, Pellenberg-Lubbeek, Belgium
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Meijer KA, Dasa V. Is resurfacing the patella cheaper? An economic analysis of evidence based medicine on patellar resurfacing. Knee 2015; 22:136-41. [PMID: 25577598 DOI: 10.1016/j.knee.2014.12.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 12/17/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Primary total knee arthroplasty is a high volume procedure which is expected to grow dramatically in the near future. The decision to resurface the patella has been discussed extensively in the literature yet the financial implications of resurfacing versus not resurfacing have not been demonstrated. METHODS We identified all randomized controlled trials comparing patellar resurfacing to nonresurfacing in the past ten years and identified the total number of patellofemoral revision surgeries for both resurfaced and nonresurfaced patellas in each study. An expected-value decision tree analysis was created using only data from the randomized controlled trials. Actual costs collected from Medicare reimbursement rates were then applied to the model and a sensitivity analysis was performed. RESULTS The expected value of primary total knee arthroplasty with patellar resurfacing was $13,788.48 while a primary total knee arthroplasty without patellar resurfacing was $14,016.41 after five years. The difference represents an additional $227.92 of Medicare dollars for every primary total knee arthroplasty performed without patellar resurfacing at five years. The model remains valid as long as patellofemoral revision rates after patellar resurfacing remain below 3.54% and patellofemoral revision rates after nonresurfaced patellas remain above 0.77%. CONCLUSIONS While initially counterintuitive, resurfacing the patella during a primary total knee arthroplasty is the optimal financial strategy from a Medicare perspective over a mid term period.
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Affiliation(s)
- Karim A Meijer
- LSU Department of Orthopaedics, 1542 Tulane Ave., Box T6-7, New Orleans, LA 70112, United States.
| | - Vinod Dasa
- LSU Department of Orthopaedics, 1542 Tulane Ave., Box T6-7, New Orleans, LA 70112, United States
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Joo JH, Lee SC, Ahn NK, Ahn HS, Jung KA. Patellar resurfacing versus no resurfacing in two-stage revision of infected total knee arthroplasty. Knee 2013; 20:451-6. [PMID: 24103410 DOI: 10.1016/j.knee.2013.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 09/07/2013] [Accepted: 09/18/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cartilage debridement and staged reimplantation are the most common treatments for infected total knee arthroplasty (TKA). Very few studies have focused on the management of primarily non-resurfaced patellae in infected TKA. The purpose of this study was to compare the outcomes of patellar resurfacing and non-resurfacing in two-stage revision of infected TKA. METHODS This study involved a retrospective comparison of the reinfection rate and clinical outcomes of revision TKA patients managed with patellar resurfacing (22 patients, 23 knees) and patients managed without patellar resurfacing (26 patients) at a minimum two-year follow-up. The mean age in the resurfacing group was 69.4years old, and the mean age in the non-resurfacing group was 67.3years old. Three scales were used in the assessment: the Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, and the Anterior Knee Pain Scale. RESULTS Three knees had recurrent infections. All infections occurred in patients who had received patellar resurfacing. There were no significant differences between groups in clinical results and on the Anterior Knee Pain Scale. A lack of patellar resurfacing did not increase recurrence of infection and did not result in significant clinical differences compared to patellar resurfacing. CONCLUSIONS This study indicates that preservation of the original patellar bone is a feasible option for patellar management in revision of septic TKA. LEVEL OF EVIDENCE Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jong-Hwan Joo
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Republic of Korea
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Wyatt MC, Frampton C, Horne JG, Devane P. Mobile- versus fixed-bearing modern total knee replacements- which is the more patella-friendly design?: The 11-year New Zealand Joint Registry study. Bone Joint Res 2013; 2:129-31. [PMID: 23836478 PMCID: PMC3728649 DOI: 10.1302/2046-3758.27.2000159] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Our study aimed to examine if a mobile-bearing total knee replacement (TKR) offered an advantage over fixed-bearing designs with respect to rates of secondary resurfacing of the patella in knees in which it was initially left unresurfaced. METHODS We examined the 11-year report of the New Zealand Joint Registry and identified all primary TKR designs that had been implanted in > 500 knees without primary resurfacing of the patella. We examined how many of these were mobile-bearing, fixed-bearing cruciate-retaining and fixed-bearing posterior-stabilised designs. We assessed the rates of secondary resurfacing of the patella for each group and constructed Kaplan-Meier survival curves. RESULTS Our study showed a significantly higher rate of revision for secondary resurfacing of the patella in the fixed-bearing posterior-stabilised TKR designs compared with either fixed-bearing cruciate-retaining or mobile-bearing designs (p = 0.001 and p = 0.036, respectively). CONCLUSIONS This New Zealand Registry study shows that during the last 11 years, revision procedures to resurface an unresurfaced patella in primary TKR occurred at a higher rate in fixed-bearing posterior-stabilised designs.
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Affiliation(s)
- M C Wyatt
- Wellington Regional Hospital, OrthopaedicDepartment, Riddiford Street, Newtown, Wellington6021, New Zealand
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Park DY, Ji HM, Kwak KS, Nair SG, Won YY. Three dimensional CT-based virtual patellar resection in female patients undergoing total knee replacement: a comparison between tendon and subchondral method. Clin Orthop Surg 2012; 4:193-9. [PMID: 22949950 PMCID: PMC3425649 DOI: 10.4055/cios.2012.4.3.193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 02/21/2012] [Indexed: 12/05/2022] Open
Abstract
Background Due to its small size, variable shape, and lack of distinct anatomical landmarks, osteoarthritic knees make a precise patellar resection extremely difficult. Methods We performed virtual patellar resection with digital software using three dimensional computed tomography scans of knees from 49 patients who underwent primary total knee replacement at our hospital. We compared 2 commonly used resection methods, the tendon method (TM) and the subchondral method, to determine an ideal resection plane with respect to the symmetry and thickness of the patellar remnant. Results The TM gave a thicker resected patella, and a less oval cut surface shape, which gives better coverage for a domed prosthesis. Both methods, however, gave a symmetric resection both superior-inferiorly, as well as mediolaterally. Conclusions Although TM appears statistically better with respect to the thickness and cut surface shape, only further intraoperative studies with long-term clinical follow-up may provide us with the most appropriate patellar resection method.
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Affiliation(s)
- Do Young Park
- Division of Arthroplasty, Department of Orthopaedics, Ajou University School of Medicine, Suwon, Korea
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Seo SS, Kim CW, Moon SW. A Comparison of Patella Retention versus Resurfacing for Moderate or Severe Patellar Articular Defects in Total Knee Arthroplasty: Minimum 5-year Follow-up Results. Knee Surg Relat Res 2011; 23:142-8. [PMID: 22570825 PMCID: PMC3341834 DOI: 10.5792/ksrr.2011.23.3.142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 06/07/2011] [Accepted: 06/14/2011] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of this study is to assess the clinical and radiological results of patients who underwent patellar retention or resurfacing for moderate or severe patellar articular defects during total knee arthroplasty and evaluate the clinical efficacy of patellar resurfacing according to the articular defect of the patella. Materials and Methods From May 2003 to March 2006, 252 patients (277 cases) underwent total knee arthroplasty by one surgeon. Intraoperatively, we divided these patients into a moderate articular defect group (50-75%: group I) and a severe articular defect group (75-100%: group II) and randomly performed patellar resurfacing. The average age was 67.2 years. There were 234 female and 17 male patients. The average follow-up period was 74.6 months. Clinical outcomes were analyzed using the Knee Society (KS) knee score. Functional score, Hospital for Special Surgery (HSS) score, Feller patellar score and range of motion (ROM). Radiological outcomes were analyzed using the congruence angle, Insall-Salvati ratio and patella tilt angle. Results The KS knee score and functional score at the last follow-up were 84.4/73.1 in the retention group and 85.2/71.8 in the resurfacing group (p=0.80, p=0.63) in group I. In group II, the values were 82.1/75.1 and 87.0/71.2, respectively (p=0.51, p=0.26). The HSS score and Feller patella score were 86.7/20.3 in the retention group and 84.3/21.7 in the resurfacing group (p=0.31, p=0.29) in group I. In group II, the values were 91.6/21.2 and 85.5/22.1, respectively (p=0.37/p=0.30). The knee ROM (p=0.36/p=0.41), congruence angle (p=0.22/p=0.16), Insall-Salvati ratio (p=0.16/p=0.21) and patella tilt angle (p=0.12/p=0.19) were not statistically different between the two groups. Conclusions In this study, we could not find any correlations between the degree of patellar articular defect and patellar resurfacing in terms of the clinical and radiological results. Therefore, patellar articular defects is thought to be less meaningful in determining patellar resurfacing.
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Affiliation(s)
- Seung Suk Seo
- Department of Orthopaedics, Inje University Pusan Paik Hospital, Inje University College of Medicine, Busan, Korea
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