Unresurfaced patella in total knee replacement: A >10-year Follow-up

Abstract

Introduction: To resurface or not to resurface the patella in total knee arthroplasty (TKA) is still controversial. Radiographic change in the unresurfaced patella articulation after TKA and how this related to clinical outcome remains understudied. Methods: Eighty-eight TKAs were performed without patella resurfacing between 2000 and 2002, all using the same brand of prosthesis (LCS, DePuy Synthes Joint Reconstruction, Warsaw [IN], United States) were assessed. Latest skyline view radiographs of each TKA were compared to the initial postoperative radiograph. Rehabilitation parameters and presence of anterior knee pain were recorded. Results: Mean duration of follow-up was 15.5 (standard deviation=1.5; range, 10-17) years. No revisions for patellofemoral issues or secondary patella resurfacing was required. 6.3% of TKAs had issues related to anterior knee pain at latest follow-up. 41% of TKAs had no evidence of radiographic changes over the patellofemoral joint (PFJ). No relationship was found between presence of PFJ radiological changes and anterior knee pain (Chi squared test, p=0.158) and postoperative rehabilitation outcomes. Postoperative pain scores and Knee Society Knee Scale scores were high. Conclusion: Patella resurfacing, a procedure fraught with risk of dire complications, may not be necessary for good outcome after TKA. Despite presence of radiological progression of patellar degenerative changes, the incidence of anterior knee pain and patellofemoral issues after TKA is low.