Affiliation:
1. Department of Trauma Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
2. Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
3. University of Edinburgh, Edinburgh, UK
Abstract
AimsThis systematic review and meta-analysis aimed to compare the influence of patellar resurfacing following cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA) on the incidence of anterior knee pain, knee-specific patient-reported outcome measures, complication rates, and reoperation rates.MethodsA systematic review of MEDLINE, PubMed, and Google Scholar was performed to identify randomized controlled trials (RCTs) according to search criteria. Search terms used included: arthroplasty, replacement, knee (Mesh), TKA, prosthesis, patella, patellar resurfacing, and patellar retaining. RCTs that compared patellar resurfacing versus unresurfaced in primary TKA were included for further analysis. Studies were evaluated using the Scottish Intercollegiate Guidelines Network assessment tool for quality and minimization of bias. Data were synthesized and meta-analysis performed.ResultsThere were 4,135 TKAs (2,068 resurfaced and 2,027 unresurfaced) identified in 35 separate cohorts from 33 peer-reviewed studies. Anterior knee pain rates were significantly higher in unresurfaced knees overall (odds ratio (OR) 1.84; 95% confidence interval (CI) 1.20 to 2.83; p = 0.006) but more specifically associated with CR implants (OR 1.95; 95% CI 1.0 to 3.52; p = 0.030). There was a significantly better Knee Society function score (mean difference (MD) -1.98; 95% CI -1.1 to -2.84; p < 0.001) and Oxford Knee Score (MD -2.24; 95% CI -0.07 to -4.41; p = 0.040) for PS implants when patellar resurfacing was performed, but these differences did not exceed the minimal clinically important difference for these scores. There were no significant differences in complication rates or infection rates according to implant design. There was an overall significantly higher reoperation rate for unresurfaced TKA (OR 1.46 (95% CI 1.04 to 2.06); p = 0.030) but there was no difference between PS or CR TKA.ConclusionPatellar resurfacing, when performed with CR implants, resulted in lower rates of anterior knee pain and, when used with a PS implant, yielded better knee-specific functional outcomes. Patellar resurfacing was associated with a lower risk of reoperation overall, but implant type did not influence this.Cite this article:Bone Joint J 2023;105-B(6):622–634.
Publisher
British Editorial Society of Bone & Joint Surgery
Subject
Orthopedics and Sports Medicine,Surgery
Reference76 articles.
1. Patella resurfacing during total knee arthroplasty is cost-effective and has lower re-operation rates compared to non-resurfacing;Parsons;J Orthop Surg Res,2021
2. Patellar resurfacing practices in primary total knee replacement: A survey of BASK members;Matharu;The Knee,2021
3. No authors listed . The American Joint Replacement Registry Annual Report . American Joint Replacement Registry . 2022 . https://www.aaos.org/registries/publications/ajrr-annual-report/ ( date last accessed 18 April 2023 ).
4. Robertsson O , W-Dahl A , Lidgren L , Sundberg M , on behalf of the Swedish Knee Arthroplasty Register . Annual Report 2020 . Swedish Knee Arthroplasty Register . 2020 . www.researchgate.net/publication/345602419_The_Swedish_Knee_Arthroplasty_RegistRe_-_Annual_report_2020 ( date last accessed 28 March 2023 ).
5. No authors listed . Characteristics of surgical practice for patients undergoing primary knee replacement . National Joint Registry . 2021 . https://reports.njrcentre.org.uk/kneesprimary-procedures-surgical-technique/K11v1NJR?reportid=26BB5DE6-C479-40EA-984C0C7FE83E3285&defaults=DC__Reporting_Period__Date_Range=%222021%7CNJR2020%22,J__Filter__Calendar_Year=%22MAX%22,H__Filter__Joint=%22Knee%22 ( date last accessed 29 March 2023 ).