A comparative study on effectiveness of patellar resurfacing against non-resurfacing in total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIA Chengqi , NI Ming , FU Jun , LI Xin , LI Xiang ,  CHAI Wei ,  CHEN Jiying

Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;

Corresponding?author：

CHAI Wei, Email: chaiwei301@163.com; CHEN Jiying, Email: chenjiying_301@163.com

Keywords：

Osteoarthritis; total knee arthroplasty; patellar resurfacing; self-control study

DOI：

10.7507/1002-1892.201708128

Video：

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ObjectiveTo investigate the effectiveness of total knee arthroplasty (TKA) with or without patellar resurfacing.MethodsBetween March 2013 and August 2015, 30 patients (60 knees) with osteoarthritis who met the inclusion criteria were recruited in the study. Of 30 cases, 24 were male and 6 were female with an average age of 57.2 years (range, 37-65 years). The body mass index ranged from 19.5 to 40.3 kg/m² (mean, 28.2 kg/m²). According to Kellgren-Lawrence grading, there were 8 cases at grand Ⅲ and 22 cases at grand Ⅳ. All patients underwent primary bilateral TKA. The patellar resurfacing was done at the unilateral knee randomly (resurfacing side); the opposite treatment was done at the other side (non-resurfacing side). The indexes of 2 groups were recorded and compared, including the intraoperative blood loss, operation time, knee society score (KSS), " Forgotten Joint” scale (FJS), anterior knee pain, anterior patellar spirant, knee constraint feeling, anterior patellar clunk, muscle power of knee extension, and ability of up and down stairs, weight-bearing flexion, squatting down, cross-legged, knee down, knee extension, and patient satisfaction. Radiographic examination was used to analyze the prosthesis position.ResultsThe operation time were (126±14) minutes and (112±11) minutes in resurfacing side and non-resurfacing side, respectively, showing significant difference between two sides (t=5.103, P=0.030); and there was no significant difference in intraoperative blood loss between two sides (t=3.431, P=0.800). All patients were followed up 2-4 years (mean, 2.6 years). There was no significant difference (P>0.05) between two sides in KSS clinical and functional scores at preoperation and 6 weeks, 6 months, and 2 years after operation; in visual analogue scale (VAS) score of anterior knee pain at preoperation and 6 weeks after operation; in incidences of anterior patellar spirant, knee constraint feeling, anterior patellar clunk, and muscle power of knee extension at 6 weeks, 6 months, and 2 years after operation; in incidences of disability of up and down stairs, weight-bearing flexion, squatting down, cross-legged, knee down, and knee extension at 6 weeks, 6 months, and 2 years after operation; in ratio of FJS score at 2 years after operation. The VAS scores at 6 months and 2 years after operation in resurfacing group were significantly lower than those in non-resurfacing group (Z=–1.997,P=0.046; Z=–2.197,P=0.028). Patient satisfaction of resurfacing side was superior to the non-resurfacing side at 6 weeks after operation (χ²=4.271, P=0.039). Radiographic examination showed no prosthesis loosing occurred.ConclusionThe effectiveness of TKA with patellar resurfacing is better than that with non-resurfacing in patients satisfaction.

Citation： JIA Chengqi, NI Ming, FU Jun, LI Xin, LI Xiang, CHAI Wei, CHEN Jiying. A comparative study on effectiveness of patellar resurfacing against non-resurfacing in total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(4): 394-399. doi: 10.7507/1002-1892.201708128 Copy

1.	Zha GC, Sun JY, Dong SJ. Less anterior knee pain with a routine lateral release in total knee arthroplasty without patellar resurfacing: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc, 2014, 22(3): 517-525.
2.	Lee GW, Lee SM, Jang SJ, et al. The efficacy of patellar decompression for improving anterior knee pain following total knee arthroplasty without patellar resurfacing. Arch Orthop Trauma Surg, 2013,133(4): 561-567.
3.	Gerbino PG 2nd, Gri?n ED, d’Hemecourt PA, et al.. Patellofemoral pain syndrome: evaluation of location and intensity of pain. Clin J Pain, 2006, 22(2): 154-159.
4.	Tokuhara Y, Kadoya Y, Kim M, et al. Anterior knee pain after total hip arthroplasty in developmental dysplasia. J Arthroplasty, 2011, 26(6): 955-960.
5.	Kim S H, Lee S, Ro DH, et al. Comparison of patellar resurfacing versus preservation in high flexion total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2015, 23(6): 1782-1790.
6.	Burnett RS, Boone JL, McCarthy KP, et al. A prospective randomized clinical trial of patellar resurfacing and nonresurfacing in bilateral TKA. Clin Orthop Relat Res, 2007, (464): 65-72.
7.	Camp CL, Bryan AJ, Walker JA, et al. Surgical technique for symmetric patellar resurfacing during total knee arthroplasty. J Knee Surg, 2013, 26(4): 281-284.
8.	Beaupre L, Secretan C, Johnston DW, et al. A randomized controlled trial comparing patellar retention versus patellar resurfacing in primary total knee arthroplasty: 5-10 year follow-up. BMC Res Notes, 2012, 5: 273.
9.	Atik OS, Uslu M. Bicompartmental knee replacement and patellar resurfacing. A prospective study with a minimum follow-up of ten years. Bull Hosp Jt Dis, 1999, 58(2): 76-78.
10.	Daniilidis K, Vogt B, Gosheger G, et al. Patellar resurfacing as a second stage procedure for persistent anterior knee pain after primary total knee arthroplasty. Int Orthop, 2012, 36(6): 1181-1183.
11.	Lee QJ, Yeung ST, Wong YC, et al. Effect of patellar thickness on early results of total knee replacement with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc, 2014, 22(12): 3093-3099.
12.	Waters TS, Bentley G. Patellar resurfacing in total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg (Am), 2003, 85-A(2): 212-217.

1. Zha GC, Sun JY, Dong SJ. Less anterior knee pain with a routine lateral release in total knee arthroplasty without patellar resurfacing: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc, 2014, 22(3): 517-525.
2. Lee GW, Lee SM, Jang SJ, et al. The efficacy of patellar decompression for improving anterior knee pain following total knee arthroplasty without patellar resurfacing. Arch Orthop Trauma Surg, 2013,133(4): 561-567.
3. Gerbino PG 2nd, Gri?n ED, d’Hemecourt PA, et al.. Patellofemoral pain syndrome: evaluation of location and intensity of pain. Clin J Pain, 2006, 22(2): 154-159.
4. Tokuhara Y, Kadoya Y, Kim M, et al. Anterior knee pain after total hip arthroplasty in developmental dysplasia. J Arthroplasty, 2011, 26(6): 955-960.
5. Kim S H, Lee S, Ro DH, et al. Comparison of patellar resurfacing versus preservation in high flexion total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2015, 23(6): 1782-1790.
6. Burnett RS, Boone JL, McCarthy KP, et al. A prospective randomized clinical trial of patellar resurfacing and nonresurfacing in bilateral TKA. Clin Orthop Relat Res, 2007, (464): 65-72.
7. Camp CL, Bryan AJ, Walker JA, et al. Surgical technique for symmetric patellar resurfacing during total knee arthroplasty. J Knee Surg, 2013, 26(4): 281-284.
8. Beaupre L, Secretan C, Johnston DW, et al. A randomized controlled trial comparing patellar retention versus patellar resurfacing in primary total knee arthroplasty: 5-10 year follow-up. BMC Res Notes, 2012, 5: 273.
9. Atik OS, Uslu M. Bicompartmental knee replacement and patellar resurfacing. A prospective study with a minimum follow-up of ten years. Bull Hosp Jt Dis, 1999, 58(2): 76-78.
10. Daniilidis K, Vogt B, Gosheger G, et al. Patellar resurfacing as a second stage procedure for persistent anterior knee pain after primary total knee arthroplasty. Int Orthop, 2012, 36(6): 1181-1183.
11. Lee QJ, Yeung ST, Wong YC, et al. Effect of patellar thickness on early results of total knee replacement with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc, 2014, 22(12): 3093-3099.
12. Waters TS, Bentley G. Patellar resurfacing in total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg (Am), 2003, 85-A(2): 212-217.

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A comparative study on effectiveness of patellar resurfacing against non-resurfacing in total knee arthroplasty

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