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Andronic O, Suravaram V, Lu V, Wall SJ, Bucher TA, Prosser GH, Yates PJ, Jones CW. What are the Outcomes of Secondary Patella Resurfacing for Dissatisfaction Following Primary Knee Arthroplasty? A Systematic Review and Meta-Analysis of 604 Knees. J Arthroplasty 2024; 39:1093-1107.e1. [PMID: 37871862 DOI: 10.1016/j.arth.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Secondary patella resurfacing is often performed for dissatisfaction following primary knee arthroplasty where the native patella was retained. The purpose of this meta-analysis was to evaluate outcomes of secondary patella resurfacing. METHODS The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting on patients who underwent secondary patella resurfacing after previous primary knee arthroplasty with retention of the native patella were considered eligible. The risk of bias was assessed using the Methodological Index for Non-Randomized studies tool. A random-effects model and the inverse-variance weighting method was used for meta-analysis. There were sixteen retrospective studies including 604 knees (594 patients) with a mean follow up of 42 months (range, 2 to 197). RESULTS An overall improvement in patient-reported outcomes (PROMs) was achieved in 53% of cases from pooled data available for 293 knees [95% Confidence Interval (CI) (0.44, 0.62), I2=68% - moderate heterogeneity]. The pooled proportion of patients satisfied with the procedure was 59% [95% CI (48, 68), I2 = 70% - moderate heterogeneity] in a sample size of 415. There was a minimal rate (2%) of complication incidence when performing secondary patella resurfacing and a pooled rate of revision surgery of 10%. CONCLUSIONS An improvement in pain, satisfaction, and PROMs was achieved in slightly more than half of the patients following secondary patella resurfacing. However, studies lacked standardized objective selection criteria for the procedure and the available data was predominantly retrospective, with high heterogeneity and variation in outcome reporting.
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Affiliation(s)
- Octavian Andronic
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia; Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Vishwa Suravaram
- Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Simon J Wall
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Thomas A Bucher
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Gareth H Prosser
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Piers J Yates
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Christopher W Jones
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia; Curtin University, Perth, Australia
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Zhang AR, Cheng QH, Yang YZ, Yang X, Zhang ZZ, Guo HZ. Meta-analysis of outcomes after total knee arthroplasty in patients with rheumatoid arthritis and osteoarthritis. Asian J Surg 2024; 47:43-54. [PMID: 37777403 DOI: 10.1016/j.asjsur.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/27/2023] [Accepted: 09/06/2023] [Indexed: 10/02/2023] Open
Abstract
The purpose of this study was to compare the difference in functional scores and the incidence of complications after TKA between RA and osteoarthritis. The PubMed, MedLine, The Cochrane Library, Embase and Web of Science databases were searched for all clinical studies up to 15 March 2023 comparing outcomes after total knee replacement in patients with RA and OA, with two review authors independently screening the literature. A total of 7,820,115 (knee-counted) cases were included in 34 studies. The results of meta-analysis showed that the scores of the RA group were lower than that of the osteoarthritis group in the postoperative knee joint score [MD=-2.72,95%CI(-5.06,-0.38),P=0.02] and the postoperative knee joint function score [MD=-11.47,95%CI(-16.55,-6.39),P<0.00001], and the difference was statistically significant. The incidence of deep venous thrombosis (OR=0.84,95%CI(0.79,0.90),P<0.00001) and pulmonary embolism (OR=0.84,95%CI(0.78,0.91),P<0.00001) were significantly lower in RA than in osteoarthritis (P<0.00001). Compared with patients with osteoarthritis, patients with rheumatoid arthritis have lower knee society scores and functional scores after total knee arthroplasty, and a higher risk of prosthetic infection, loosening, and revision, but TKA can still effectively reduce pain in RA patients, Improve function and quality of life without increasing the risk of lower extremity venous thrombosis and pulmonary embolism. Therefore, total knee replacement can be used as a treatment option for patients with rheumatoid arthritis who have not responded to conservative treatment. Patients should fully understand the benefits and possible risks of total knee replacement and develop an individualized treatment plan.
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Affiliation(s)
- An-Ren Zhang
- First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, China; Gansu Provincial Hospital, Lanzhou, China.
| | | | - Yong-Ze Yang
- First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, China; Gansu Provincial Hospital, Lanzhou, China
| | - Xin Yang
- First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, China; Gansu Provincial Hospital, Lanzhou, China
| | - Zhuang-Zhuang Zhang
- First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, China; Gansu Provincial Hospital, Lanzhou, 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] [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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Held MB, Gazgalis A, Sarpong NO, Geller JA, Shah RP, Cooper HJ. Management of the Patella During Total Knee Arthroplasty. JBJS Rev 2021; 9:01874474-202109000-00011. [PMID: 34516451 DOI: 10.2106/jbjs.rvw.21.00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The optimal management of the patella during total knee arthroplasty (TKA) remains a controversial topic with no consensus. » Patellar management techniques during TKA include patellar retention or resurfacing with or without patellaplasty, as well as circumferential denervation and partial lateral facetectomy (PLF). » Special considerations such as patient age, etiology of disease, implant design, and surgeon preference should be accounted for when determining optimal management. » We recommend that most patellae be circumferentially denervated, regardless of whether they are resurfaced, as the potential benefits outweigh the small associated risks. » Evidence demonstrates improved functional outcomes with the addition of PLF to nonresurfaced patellae. There is currently a paucity of evidence of this technique with respect to resurfaced patellae. » Patellar resurfacing adds additional costs and health-care resources that should be considered in the decision-making process.
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Affiliation(s)
- Michael B Held
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
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Benazzo F, Perticarini L, Jannelli E, Ivone A, Ghiara M, Rossi SMP. Controversy: supporting patellar resurfacing in total knee arthroplasty - do it. EFORT Open Rev 2020; 5:785-792. [PMID: 33312705 PMCID: PMC7722947 DOI: 10.1302/2058-5241.5.190075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Patellar resurfacing during total knee arthroplasty remains a controversial topic.Some surgeons routinely resurface the patella to avoid the increased rates of postoperative anterior knee pain and reoperation for secondary resurfacing, whilst others selectively resurface based on the presence of preoperative anterior knee pain, damaged articular cartilage, inflammatory arthritis, isolated patellofemoral arthritis, and patellar subluxation and/or maltracking. A third group of surgeons never resurface the patella.The anatomy and biomechanics of the patellofemoral joint as well as the advances in surgical techniques and prosthetic design must be taken into account when making a decision about whether to resurface the patella. Accurate component implantation if the patella is resurfaced becomes crucial to avoid complications.In our institution before 2008 we were performing a selective resurfacing of the patella, but in the last decade we have decided to always resurface it, with good outcomes and low complication rate. A reproducible surgical technique may be helpful in reducing the risk of postoperative anterior knee pain and complications related to implants.In this article we analyse the current trend and controversial topics in dealing with the patella in total knee arthroplasty, and discuss the available literature in order to sustain our choice. Cite this article: EFORT Open Rev 2020;5:785-792. DOI: 10.1302/2058-5241.5.190075.
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Affiliation(s)
- Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Brescia, Lombardy, Italy.,Università degli Studi di Pavia, Pavia, Lombardy, Italy
| | - Loris Perticarini
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Brescia, Lombardy, Italy
| | - Eugenio Jannelli
- Clinica Ortopedica e Traumatologia, Fondazione IRCCS Policlinico San Matteo - Pavia, Lombardy, Italy
| | - Alessandro Ivone
- Clinica Ortopedica e Traumatologia, Fondazione IRCCS Policlinico San Matteo - Pavia, Lombardy, Italy
| | - Matteo Ghiara
- Clinica Ortopedica e Traumatologia, Fondazione IRCCS Policlinico San Matteo - Pavia, Lombardy, Italy
| | - Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Brescia, Lombardy, Italy
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Wang Y, Feng W, Zang J, Gao H. Effect of Patellar Denervation on Anterior Knee Pain and Knee Function in Total Knee Arthroplasty without Patellar Resurfacing: A Meta-Analysis of Randomized Controlled Trials. Orthop Surg 2020; 12:1859-1869. [PMID: 33112040 PMCID: PMC7767783 DOI: 10.1111/os.12815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/05/2020] [Accepted: 08/25/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate the effect of patellar denervation (PD) in preventing anterior knee pain (AKP) and improving knee function after total knee arthroplasty (TKA) without patellar resurfacing, and to help surgeons decide whether or not to use PD in TKA. METHODS The electronic databases of Pubmed, Embase, Cochrane, Web of Science, and Scopus were searched for all randomized controlled trials (RCT) comparing the outcomes of PD and no patellar denervation (NPD) in TKA without patellar resurfacing. Primary outcomes were incidence of AKP, visual analogue scale for pain (VAS), and patellar score (PS). Secondary outcomes were Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Knee Score (OKS), knee range of motion (ROM), and complications. RESULTS A total of nine RCT met the inclusion criteria. On meta-analysis, PD significantly reduced the incidence of AKP (odds ratio 0.49; 95% confidence interval [CI] 0.26 to 0.92), reduced the VAS (weighted mean difference [WMD] -0.57; 95% CI -1.02 to -0.11), and improved the WOMAC (WMD -4.63; 95% CI -6.49 to -2.77) and the ROM (WMD 9.60; 95% CI 0.39 to 18.81) during the follow-up within 12 months. In addition, PD improved the PS (WMD 1.01; 95% CI 0.65 to 1.38), KSS (WMD 1.12; 95% CI 0.10 to 2.14), and the WOMAC (WMD -1.41; 95% CI -2.74 to -0.08) during the follow-up after 12 months. CONCLUSION Patellar denervation could significantly reduce the VAS and the incidence of AKP in the early stages after TKA as well as improve the clinical outcomes in terms of the PS, the WOMAC, the KSS, and the ROM. This study demonstrates that PD is a safe and recommendable technique that could be routinely performed in TKA.
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Affiliation(s)
- Yuhang Wang
- Day Care Unit, The First Hospital of Jilin University, Changchun, China
| | - Wei Feng
- Department of Orthopaedics, The First Hospital of Jilin University, Changchun, China
| | - Junting Zang
- Department of Orthopaedics, The First Hospital of Jilin University, Changchun, China
| | - Hang Gao
- Department of Orthopaedics, The First Hospital of Jilin University, Changchun, China
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