No difference in clinical outcome and survivorship after total knee arthroplasty with patellar resurfacing and nonresurfacing after minimum 10-year follow-up

Patellar resurfacing might not be mandatory in contralateral second total knee replacement even if performed during replacement of the first knee

INTRODUCTION

The appropriateness or necessity of patellar resurfacing in total knee arthroplasty (TKA) is not clearly established. The objective of the present study was to compare the clinical and functional results of patients with bilateral involvement, operated on in one knee by TKA with patellar resurfacing and in the other knee by TKA without resurfacing. The hypothesis was that there was no difference in results between the two sides.

METHOD

This was a retrospective cohort of patients operated on by TKA without patellar resurfacing in a second osteoarthritic knee after contralateral TKA with patellar resurfacing. Twenty consecutive patients who underwent second primary TKA constituted their own control group (40 knees). Iwano scores were comparable. Mean age was 75.9±6.2years. Mean time between the two procedures was 20.6±11.9months.

RESULTS

There were no differences in SF-36, KOOS or Lille patellofemoral scores between the right and left knees. Sixty-five percent of patients were unable to differentiate the performance of their knees in activities of daily living.

CONCLUSION

The present study did not differentiate results according to patellar resurfacing, showing the limitations of resurfacing for early functional gain after primary TKA. Resurfacing might thus not be essential, even if it was performed in replacement of the first knee.

LEVEL OF EVIDENCE

IV; retrospective cohort study.

Long-term clinical outcomes following total knee arthroplasty in patients with hemophilic arthropathy: a single-surgeon cohort after a 10- to 17-year follow-up

BACKGROUND

Total knee arthroplasty (TKA) can reduce severe joint pain and improve functional disability in hemophilia. However, the long-term outcomes have rarely been reported in China. Therefore, this study aimed to evaluate the long-term outcomes and complications of TKA in Chinese patients with hemophilic arthropathy.

METHODS

We retrospectively reviewed patients with hemophilia who underwent TKA between 2003 and 2020, with at least 10 years of follow-up. The clinical results, patellar scores, patients' overall satisfaction ratings, and radiological findings were evaluated. Revision surgery for implants during the follow-up period was recorded.

RESULTS

Twenty-six patients with 36 TKAs were successfully followed up for an average of 12.4 years. Their Hospital for Special Surgery Knee Score improved from an average of 45.8 to 85.9. The average flexion contracture statistically significantly decreased from 18.1° to 4.2°. The range of motion (ROM) improved from 60.6° to 84.8°. All the patients accepted patelloplasty, and the patients' patellar score improved from 7.8 preoperatively to 24.9 at the last follow-up. There was no statistically significant difference in clinical outcomes between the unilateral and bilateral procedures, except for a better ROM at follow-up in the unilateral group. Mild and enduring anterior knee pain was reported in seven knees (19%). The annual bleeding event was 2.7 times/year at the last follow-up. A total of 25 patients with 35 TKAs were satisfied with the procedure (97%). Revision surgery was performed in seven knees, with 10- and 15-year prosthesis survival rates of 85.8% and 75.7%, respectively.

CONCLUSIONS

TKA is an effective procedure for patients with end-stage hemophilic arthropathy, which relieves pain, improves knee functions, decreases flexion contracture, and provides a high rate of satisfaction after more than ten years of follow-up.

Patella component diameters of 38 mm and up might be associated with higher revision rates after patella resurfacing

PURPOSE

Patellar resurfacing is considered the standard of care for total knee arthroplasty in the USA. Complications of patella resurfacing include aseptic loosening or patella fractures and can threaten the integrity of the extensor mechanism. The goal of this study was to report on patella button revision rates in posterior stabilized total knee arthroplasty.

MATERIAL AND METHODS

Between 01/2010 and 08/2016 patella buttons were implanted in 1056 patients (267 men and 550 women) as part of a posterior stabilized total knee arthroplasty.

RESULTS

Of 1056 cases, 35 cases (14 women, 15 men, 5 bilateral, 3.3%) showed early loosening at a mean 52.5 months postoperatively. Patella components of 38 mm or larger diameters showed a significantly higher loosening rate than the 29, 32, 35 mm buttons (p < 0.01). Mean BMI of patients identified with aseptic loosening was 31.7 kg/m², mean age at time of revision surgery was 63.3 years. All of the patients with loosening of the patella button required revision surgery; in 33 cases an exchange of the button was performed, in two cases a removal of the button and patellar bone grafting was indicated. No complications occurred after revision surgery.

CONCLUSION

The current study reports a 3.3% patella loosening rate during this mid-term follow-up. Size 38 mm and larger patella components showed a significantly higher revision rate than smaller buttons and the authors advise caution when using large diameter patella components.

Patellar resurfacing in total knee arthroplasty leads to better isokinetic performance

BACKGROUND

For decades there have been concerns about patellar resurfacing (PR) in total knee arthroplasty (TKA) and the individual preference of the surgeon is still the main determinant of whether or not resurfacing is applied. According to preference, surgeons can be categorized in 3 main groups of those who usually, selectively, or rarely resurface. The aim of this prospective, randomized, controlled study was to compare the isokinetic performance and clinical outcome of TKAs with PR and without PR.

METHODS

A total of 50 patients scheduled to undergo TKA for primary osteoarthritis of the knee were randomly assigned to either the PR or non-PR groups. There were no significant differences between the groups in respect of age, BMI, gender and preoperative Knee Society Score (KSS) and isokinetic performance. Patients were evaluated at postoperative 3, 6, and 12 months with KSS and at 6 months and 1 year with isokinetic measurements.

RESULTS

The PR group had a higher mean score, especially in the functional component of KSS, but the difference was not statistically significant. Knee extension peak torque was significantly higher in the PR group at 6 months (p = 0.029) and 1 year (p = 0.004) postoperatively. There were no significant differences between the groups in respect of knee flexion peak torque values following TKA.

CONCLUSIONS

The results of this study demonstrated that PR during TKA is associated with better isokinetic performance and higher knee scores. These results support routine/usually resurfacing of the patella. For surgeons who selectively resurface the patella, the advantage of better isokinetic performance may be taking into consideration in favor of resurfacing the patella where they are undecided.

LEVEL OF EVIDENCE

Level I, therapeutic study.

Patellar resurfacing versus nonresurfacing in total knee arthroplasty: an updated meta-analysis of randomized controlled trials

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.