Cochrane Database of Systematic Reviews Patella resurfacing in total knee arthroplasty (Protocol) (original) (raw)
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Patella resurfacing in total knee arthroplasty (Protocol)
Cochrane Database Syst Rev, 2009
This is the protocol for a review and there is no abstract. The objectives are as follows: To identify and summarise the evidence from randomised controlled trials assessing the clinical efficacy and safety of resurfacing the patella versus not resurfacing the patella in total knee arthroplasty. The following null hypotheses will be tested: 1.There is no difference in outcome between resurfacing the patella and not resurfacing the patella in patients with osteoarthritis of the knee. 2.There is no difference in outcome between resurfacing the patella and not resurfacing the patella in patients with inflammatory arthritis of the knee. 3.There is no difference in outcome between not resurfacing the patella and resurfacing the patella with different prosthetic designs. 4.There is no difference in outcome between resurfacing the patella and not resurfacing the patella in patients with grade varying grades of patellofemoral arthritis, and varus or valgus deformity of the knee.
Patellar resurfacing in total knee arthroplasty (Protocol)
Cochrane Database Syst Rev, 2004
This is the protocol for a review and there is no abstract. The objectives are as follows: To identify and summarise the evidence from randomised controlled trials assessing the clinical efficacy and safety of resurfacing the patella versus not resurfacing the patella in total knee arthroplasty. The following null hypotheses will be tested: 1.There is no difference in outcome between resurfacing the patella and not resurfacing the patella in patients with osteoarthritis of the knee. 2.There is no difference in outcome between resurfacing the patella and not resurfacing the patella in patients with inflammatory arthritis of the knee. 3.There is no difference in outcome between not resurfacing the patella and resurfacing the patella with different prosthetic designs. 4.There is no difference in outcome between resurfacing the patella and not resurfacing the patella in patients with grade varying grades of patellofemoral arthritis, and varus or valgus deformity of the knee.
Patella resurfacing in total knee arthroplasty: A review of current literature
2014
Introduction The issue of patella resurfacing following Total Knee Arthroplasty (TKA) has always been controversial among Orthopaedic surgeons. There are a lot of arguments, for or against patella resurfacing; and a lot of evidence has been published to support or discourage the procedure. Therefore, this review, aims to analyse the evidence in the literature, for or against patella resurfacing, with a view to finding out which has more support and better outcomes for patients. Methods This is a narrative review of the literature to find the relevant articles related to patella resurfacing after TKA. A search was carried out on Pubmed using the appropriate words to come up with any published evidence regarding this procedure. These articles were read by the authors and relevant arguments for or against the procedure were documented and critically analysed. Results Many articles gave advantages and disadvantages for patella resurfacing following TKA. However, most of them are in favour of selective resurfacing or non-resurfacing of the patella, on a case by case basis. There is also need to discuss the issue fully with patients, and make them understand why such a decision is taken, in order to avoid misplaced expectations or disappointment if complications arise. Discussion and Conclusion TKA is a reliable procedure used to correct knee deformities, relieve pain and improve knee function usually following arthritis. Anterior knee pain is a major post-operative complication that compromises patient's satisfaction. This led to several techniques of treatment to be proposed, which include patella denervation and resurfacing. However, patella resurfacing has become a controversial issue, which necessitates proper review of the literature, with a view to establishing the strongest evidence available in support of the procedure. However, from the review of current literature, there is no sufficient evidence to support the idea of routine resurfacing or nonresurfacing of the patella. Therefore, it may be more sensible to selectively resurface the patella based on an objective assessment of pre-operative symptoms, radiographic images and intra-articular findings of the arthritis affecting the patello-femoral joint. There is also need to involve the patient in the decision so that we can have an informed consent before carrying out the procedure.
2020
Background/Aim: To compare clinical outcomes between patellar resurfacing and nonresurfacing in total knee arthroplasty (TKA). Materials and Methods: Data from osteoarthritis patients who underwent TKA and were followed up for ≥ 4.5 years were analysed retrospectively. Patients were divided into two groups: patellar nonresurfacing group and patellar resurfacing group. In the Nonresurfacing group, the partial lateral facet of the patella was removed, the patella was reshaped to match the trochlea of the femoral prosthesis and circumpatellar denervation was performed. In the resurfacing group, the patella was resurfaced with a cemented component. Clinical outcomes included incidence of anterior knee pain, Knee Society Score, patient satisfaction, revision rate and radiographic findings. Fisher’s exact test was used to assess nominal data including the incidence of AKP, patient satisfaction score, and revision rate. P values < 0.05 were considered to be statistically significant. Re...
Evidence in orthopaedics: patellar resurfacing in total knee arthroplasty
Journal of Orthopaedics and Traumatology, 2004
Four good quality randomized clinical trials comparing patellar resurfacing versus noresurfacing in knee arthroplasty are analyzed. The outcomes evaluated were anterior knee pain, scores on the Knee Society’s rating system and reoperation. No relevant differences were found in knee scores, but anterior knee pain was less frequent in patients with patellar resurfacing. Few patients had severe anterior knee pain. Still, patients with anterior knee pain were less satisfied with the clinical result. Studies with longer follow-up showed that anterior knee pain increased with time in both groups. A clinically relevant increase in reoperation rate in the nonresurfaced group could not be excluded with the numbers available. Anterior knee pain seems to be influenced by the decision of resurfacing the patella during knee arthoplasty. Although it is not associated with important changes in knee scores, patients perceive it as a cause of insatisfaction. Influence of patellar resurfacing on implant supervivence is not clear.
2018
Background There is no difference in the functional outcomes 6 months after total knee arthroplasty (TKA) for knee osteoarthritis between patellar resurfacing and non-resurfacing. Thus, we have performed this study to compare the short-term clinical outcomes of TKA performed with and without the patella resurfacing. Methods A total of 50 patients with osteoarthritis of the knee (OAK) were randomized to receive patellar resurfacing (n=24; resurfaced group) or to retain their native patella (n=26; non-resurfaced group) based on envelope selection and provided informed consent. Disease specific outcomes including Knee Society Score (KSS), Knee Society Function Score (KSKS-F), Kujala Anterior Knee Pain Scale (AKPS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Short Form 36 (SF-36), and functional patella-related activities were measured within six months of follow-up. Results There was no significant difference between the resurfaced and non-resurfaced groups in p...
Patellar Resurfacing in Primary Total Knee Replacement
The Journal of Bone and Joint Surgery-American Volume, 2012
Background: Treatment of the patella during total knee replacement is an area of continuing debate. We performed a meta-analysis of randomized controlled trials to address the hypothesis that patellar resurfacing in primary total knee replacement improved patient outcome. IVIethods: Randomized controlled trials comparing patellar resurfacing with nonresurfacing in primary total knee replacement were included. The primary outcomes analyzed were knee scores, anterior knee pain, and patient satisfaction. We also investigated the prevalence of complications, revision surgery related specifically to the patellofemoral joint, the infection rate, operative time, and radiographie appearance. Results: Sixteen randomized controlled trials assessing 3465 knee replacements were eligible; 1710 procedures included patellar resurfacing and 1755 did not. The knee component of the Knee Society Score was significantly higher in the resurfacing group (p = 0.005); however, no significant difference was observed forthe function component of the Knee Society Score or for any other reported knee score. Anterior knee pain was reported in 13% of resurfaced knees and in 24% of nonresurfaced knees; this difference was not significant (p = 0.1). Patients were satisfied with the outcome after 485 (90%) of 539 procedures that included patellar resurfacing compared with 488 (89%) of 548 that did not; this difference was not significant. There were ninety-three reported patellofemoral complications in the resurfacing group and 205 in the nonresurfacing group; this difference was significant (p = 0.02) in a random-effect model. The rate of reoperation because of anterior knee pain (p < 0.00001) and the rate of reoperation because of any patellofemoral complication (p = 0.002) were significantly higher in the nonresurfaced group. No differences were found in the analyses of infection rate, operative time, or radiographie appearance. Conclusions: Patients who underwent patellar resurfacing experienced anterior knee pain and satisfaction with the arthroplasty procedure that were equivalent to those experienced by patients whose patella was not resurfaced; however, these patients underwent significantly fewer additional surgical procedures. Further long-term follow-up of modern prostheses in randomized studies measuring outcome with a patella-specific score is needed.
Effect of patella resurfacing on functional outcome and revision rate in primary total knee arthroplasty (Review), 2022
Anterior knee pain, as well as patellofemoral disorders, after total knee arthroplasty are important reasons for revision in total knee arthroplasty. Current prosthesis designs include patellar components for patella replacement, and together with improved rational design of the prosthesis and advancement in knee alignment these appear to reduce the incidence of anterior knee pain following total knee replacement, even if the etiology of anterior knee pain remains unclear. However, new complications related to patella resurfacing emerge with this approach. At present, there are three strategies involving patella replacement in total knee arthroplasty: There are surgeons who always replace the patella, others who never resurface the patella and a third group of surgeons who usually do not resurface the patella but replace the patella in particular situations. There are arguments to support each of these viewpoints regarding patella resurfacing but no strong arguments to favor any of them. Finally, the decision to resurface the patella or not should be based on the practice, training and experience of individual surgeons. The aim of this review was to analyze the results of different strategies for patella resurfacing in terms of functional outcome and revision rate following primary total knee arthroplasty.
Journal of Orthopaedic Surgery and Research
Background The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon’s preference, education, training, tradition and geographic location. Advocates for non-resurfacing or selectively resurfacing may claim no difference in patient reported outcomes, and that resurfacing is associated with increased risks such as extensor mechanism injury or malalignment, problems with the design of the patella component and technical issues intraoperatively. Aims To critically examine factors that should be considered in addition to patient reported outcomes in the decision process of resurfacing or non-resurfacing of the patella in total knee arthroplasty. Method A comprehensive literature search was conducted to identify factors that may influence decision making in addition to knee specific patient reported outcome measures such as surgical risks, patient quality of life, procedure cost, re-operation rate, implant design, surgeons learning curve and...