髌骨软骨破坏程度对保留髌骨的全膝关节置换术疗效的影响

目的 探讨髌骨软骨破坏程度对保留髌骨的全膝关节置换术疗效的影响.方法 2002年1月至2006年5月行全膝关节置换术163例244膝,根据术中观察到的髌骨软骨破坏程度将患者分为轻度、中度、重度软骨破坏三组.所有手术均不置换髌骨.术后随访88例133膝,轻度组42膝,中度组43膝,重度组48膝.采用美国膝关节学会评分(Knee Society Score,KSS)系统(包括膝评分和膝功能评分)和膝前痛评分系统对三组疗效进行评估.结果 随访48～102个月,平均72个月.KSS膝评分和膝功能评分从术前(35.1±5.4)分和(19.2±9.8)分分别提高到(91.7±5.6)分和(83.7±17.5)分.三组KSS膝评分从术前(34.7±6.2)分、(36.5±5.2)分、(35.3±6.2)分分别提高至(92.6±4.5)分、(90.5±6.7)分、(91.9±5.9)分;膝功能评分从术前(14.2±8.6)分、(16.5±7.4)分、(17.0±7.5)分分别提高至(86.6±12.6)分、(82.0±17.2)分、(82.8±21.1)分.三组术后膝评分和膝功能评分的差异均无统计学意义.术后膝前痛的发生率为11.3%(15/133),轻度、中度、重度软骨破坏组分别为11.9%(5/42)、11.6%(5/43)、10.4%(5/48),差异无统计学意义.结论 全膝关节置换术后疗效及膝前痛的发生率与术前髌骨软骨破坏程度无关,髌骨软骨破坏程度不是全膝关节置换术中置换髌骨的可靠依据.

Abstract：

Objective To determine whether there was any correlation between the degree of degenerative changes in the patellar cartilage and the clinical outcome after TKA without patellar resurfacing.Methods A clinical study was performed on 133 knees of 88 patients that underwent TKA without patellar resurfacing from January 2002 to May 2006. According to the degenerative condition of the patellar cartilage,patients was classified as mild group, moderate group, and severe group. Pre- and post-operative evaluations were performed using the knee and function scores of the Knee Society Clinical Rating System (KSS) and Anterior Knee Pain Rating. Results The duration of follow-up was 72 months (range 48-102). The overall knee score of KSS in all patients were improved from 35.1±5.4 preoperatively to 91.7±5.6 postoperatively,and function score of KSS from 19.2±9.8 preoperatively to 83.7±17.5 postoperatively. The mean knee scores of KSS were improved from 34.7±6.2, 36.5±5.2 and 35.3±6.2 preoperatively to 92.6±4.5, 90.5±6.7 and 91.9±5.9 in mild, moderate, and severe group postoperatively, respectively. The mean function scores of KSS were improved from 14.2±8.6, 16.5±7.4 and 17.0±7.5 postoperatively to 86.6±12.6, 82.0±17.2 and 82.8±21.1 in mild, moderate, and severe group postoperatively, respectively. There was no difference among all groups with regard to the postoperative knee scores and function scores of KSS. The prevalence of anterior knee pain was 11.3% in all, and 11.9% in mild group, 11.6% in moderate group and 10.4% in severe group. There was no difference among all groups with regard to the anterior knee pain. Conclusion The clinical outcome and anterior knee pain after TKA without patellar resurfacing was not correlated with the severity of degenerative changes in the patellar cartilage. The degree of degenerative condition of the patellar cartilage is not indication for patellar resurfacing.     

Patelloplasty versus traditional total knee arthroplasty for osteoarthritis

The purpose of this study was to compare the clinical effects of patelloplasty and traditional patellar management in total knee arthroplasty (TKA) for osteoarthritis. A total of 152 patients with osteoarthritis treated with TKA between January 2004 and December 2005 were retrospectively studied. The patients were randomly divided into 2 groups: the patelloplasty group (group A; n=76) and the traditional treatment group (group B; n=76). Knee Society Score (KSS), Feller patellar score, Lonner patellar score, patient satisfaction, joint range of motion (ROM), and incidence of postoperative anterior knee pain were compared between the groups. Mean follow-up was 55 months (range, 48-71 months) for 132 patients, including 68 patients in group A and 64 in group B. Significant differences were found in KSS functional score, Feller patellar score, Lonner patellar score, and patient satisfaction, but no significant differences were found in ROM and total KSS score between the groups postoperatively. Group A obtained higher KSS scores and patient satisfaction than group B, with no significant difference in postoperative anterior knee pain. Postoperative radiographs revealed a significant difference in patellofemoral congruence between the groups. Patelloplasty relieves pain, enhances patient satisfaction, and improves function better than traditional patellar management in TKA with patellar nonresurfacing.     

Short-term differences in anterior knee pain and clinical outcomes between rotating and fixed platform posterior stabilized total knee arthroplasty with a new femoral component design

AIM To compare rotating versus fixed-bearing Press-Fit Condylar(PFC) Sigma posterior stabilized(PS) total knee arthroplasty(TKA) with the new "J curve"femoral design in terms of clinical outcomes and anterior knee pain.METHODS We retrospectively analyzed 39 patients who underwent primary total knee replacement surgery for knee osteoarthritis using the PFC Sigma PS TKA with either fixed(FP group, 20 cases) or rotating platform(RP group, 19 cases) treated between 2009 and 2013 by the same surgeon. The two groups were homogeneous for age, gender, weight, American Society of Anesthesiologists status, preoperative clinical and functional scores, and prosthetic alignment at two years after surgery. We analyzed clinical outcomes score at two years follow-up using Knee Society Score(KSS), Knee Injury and Osteoarthritis Outcome Score(KOOS),Knee Performance Score, Short Form(SF) 36, and anterior knee pain assessed by the Hospital for Special Surgery(HSS) patellar score.RESULTS No differences were found in KSS, Knee Performance Score, and SF-36 outcome scores. A statistically significant difference was found in the HSS Patella score objective(FP: 22.36; RP: 28.75; P 0.05), HSS Patella score total(FP: 73.68; RP:86.50; P 0.05), and KOOS symptoms(FP: 73.49; RP: 86.44; P 0.05).CONCLUSION Rotating platform in PFC Sigma PS TKA appears to reduce the short-term incidence of anterior knee pain compared to the fixed platform.     

全膝关节置换术中髌骨置换与否对早期疗效及膝前痛的影响

 目的 探讨全膝关节置换术中髌骨置换与否对早期疗效及膝前痛发生率的影响。方法 2010年6月至2011年6月拟行全膝关节置换术患者100例,随机分为两组：髌骨置换组43例50膝,髌骨未置换组57例66膝。比较术后6个月、12个月两组患者的西安大略和麦克马斯特大学(West Ontario and McMaster Universities,WOMAC)骨关节炎指数、美国膝关节外科协会(Knee Surgery Society,KSS)膝评分和功能评分、膝前痛视觉模拟评分(visual analogue scale,VAS)。结果 髌骨置换组与髌骨未置换组患者术后膝前痛VAS评分均较术前明显降低,两组间VAS评分及膝前痛发生率的差异无统计学意义。WOMAC骨关节炎指数6个月分别为28.8±11.2和18.6±7.2、术后12个月分别为20.7±6.2和16.0±5.5,KSS膝评分6个月分别为(87.0±8.3)分和(90.9±7.2)分、术后12个月分别为(84.2±10.6)分和(88.8±9.2)分,KSS功能评分术后6个月分别为(86.6±21.6)分和(84.9±16.5)分、术后12个月分别为(85.2±16.4)分和(91.0±10.0)分,组间差异均无统计学意义。髌骨轴位X线片示髌骨与股骨假体滑车吻合度良好,无不稳及脱位表现。术后1年内无翻修、髌骨表面再置换病例。结论 全膝关节置换术对改善因骨关节炎或类风湿关节炎导致的膝关节疼痛、功能受限有效;髌骨置换与否对术后短期疗效及膝前痛发生率没有影响。     

髌骨钻孔减压改善全膝关节置换术后膝前疼痛

目的探讨通过髌骨钻孔减压术改善全膝关节置换术(TKA)后膝前痛的临床疗效。方法将符合标准的113例行TKA的骨关节炎患者按数字法随机分为两组:54例为减压组,TKA术中联合髌骨钻孔减压术;59例为非减压组,仅施行TKA不联合髌骨钻孔减压术。术后观察两组患者切口愈合情况、相关并发症、KSS评分及膝前痛发生率。结果两组患者切口均一期愈合,无严重并发症发生,113例均获满12个月的完整随访。KSS评分:减压组术后明显高于非减压组;术后膝前痛的发生率明显低于非减压组,差异均有统计学意义(P0.05)。结论 TKA术中联合髌骨减压术可以在一定程度上改善膝关节KSS评分及降低术后膝前疼痛的发生率。     

膝关节骨关节炎患者初次全膝关节置换术中选择髌骨置换的Meta分析

目的探讨膝关节骨关节炎(OA)进行初次全膝关节置换术(TKA)中选择髌骨置换与否的疗效,评价两种不同治疗选择的差异。方法检索Medline、Embase、Cochranelibrary、CBM,收集膝关节OA行初次TKA术中髌骨置换与否的临床对照试验,提取数据分析,采用RevMan5.0.18进行Meta分析。结果纳入8个前瞻性随机对照试验,共822例手术,其中髌骨置换组373例,髌骨非置换组444例。髌骨置换与非置换组比较,前膝痛与KSS评分均无明显的统计学意义(P0.5),置换组的因髌股关节问题而再次手术率低于非置换组[RR=0.53,95%CI(0.29,0.96),P=0.04],但置换组再次手术的原因除了常见的前膝痛,还包括髌骨假体相关的并发症。结论膝关节OA的患者行初次TKA术中选择髌骨置换与否的前膝痛与KSS评分无明显的统计学意义,置换组的因髌股关节问题再次手术率低于非置换组,但置换组再次手术的复杂性大于非置换组。     

Patellar Resurfacing in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

BackgroundThe management of the patella during total knee arthroplasty (TKA) remains controversial. The aim of this study is to evaluate the evidence regarding the use of patellar resurfacing in TKA.MethodsA meta-analysis of randomized controlled trials (RCTs) was performed to compare outcomes between knees receiving patellar resurfacing vs those not receiving resurfacing during primary TKA. Outcomes of interest were the Knee Society Scores, reoperation rates, anterior knee pain, patient satisfaction, Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score subscores, and range of motion.ResultsTwenty RCTs met all eligibility criteria and were included in the analysis. There were statistically significant differences favoring the resurfaced group in the knee component and functional component of Knee Society Scores that were not clinically significant. There was an increased risk of reoperation among knees that did not receive resurfacing with number needed to treat to prevent one case of reoperation of 25 knees (for reoperation for any reason) and 33 knees (for reoperation for anterior knee pain). There were no statistically significant differences in any other outcomes.ConclusionThe only clear relationship is that knees that do not receive patellar resurfacing are more likely to receive reoperation, most often for secondary resurfacing. However, the disease burden of differing complication profiles associated with resurfacing and nonresurfacing groups remains unclear. Continuing to collect data from large, well-designed RCTs would be beneficial in guiding management of the patella during TKA.     

Partial Lateral Patellar Facetectomy as an Alternative to Lateral Release in Total Knee Arthroplasty (TKA)

This study presents the selective use of partial patellar lateral facetectomy for maltracking during primary TKA, as an alternative to lateral release. Twenty three partial facetectomies were performed out of 191 TKAs (12%). Balanced tracking was achieved in 22 knees. At follow-up 2 patients had persistent anterior knee pain. Mean Knee Society score (KSS) was 94 and mean functional KSS was 86. Mean patellar score was 28. Patellar tilt angles were within 2 degrees in all but one knee. Patellar translation was within 2 mm in all cases. No complications were recorded. A control group of 46 matched patients had similar functional and radiographic results. If tracking is not satisfactory at the conclusion of TKA, our method of choice would be partial lateral facetectomy.     

Isolated Resurfacing of the Previously Unresurfaced Patella Total Knee Arthroplasty

Postoperative anterior knee pain can be challenging after primary total knee arthroplasty. Isolated patellar resurfacing may provide symptomatic improvement in those patients with an unresurfaced patella. Seventeen isolated patellar resurfacing procedures were performed. Patient outcomes were evaluated using the Knee Society clinical and roentgenographic evaluation systems. Continued symptomatology and overall patient satisfaction were also analyzed. No revisions have been necessary at 47 months of follow-up. Overall, Knee Society knee scores and knee function scores significantly improved. Eight patients (53%) are asymptomatic and were satisfied with the procedure, whereas 7 patients (47%) continue to have anterior knee pain and are unsatisfied. Isolated patellar resurfacing for anterior knee pain in total knee arthroplasty with an unresurfaced patella has a low morbidity and revision rate but may not provide patients with predictable symptomatic improvement.     

The efficacy of patellar decompression for improving anterior knee pain following total knee arthroplasty without patellar resurfacing

Background

Anterior knee pain remains common following total knee arthroplasty (TKA). In this study, we evaluated the efficacy of patellar decompression via drilling for the treatment of anterior knee pain following TKA without patellar resurfacing.

Methods

A prospective cohort study was performed in 271 consecutive patients who underwent primary total knee replacement with patellar decompression (study group, n = 131) or without decompression (control group, n = 140). The patients were assessed according to the Knee Society rating, clinical anterior knee pain score, and British Orthopaedic Association patient-satisfaction score in each group. Each assessment was performed without the examiner knowing whether the patella had been decompressed. Radiographic evaluations were also performed according to the Knee Society scoring system for functional activity and our own severity grade system for patellofemoral articular change.

Results

There were no adverse events following patellar decompression. The overall prevalence of anterior knee pain was not significantly different between groups (p = 0.71). However, patients presenting pain over grade II after the operation in the study group were statistically low (p = 0.01). The overall postoperative knee scores were higher in the study group, but there were no significant differences between groups (p = 0.0731). Analyses of the radiographs revealed similar postoperative outcomes in both groups of knees.

Conclusions

As we observed significantly lower rates of anterior knee pain and no patellar complications following patellar decompression via drilling in TKA without patellar resurfacing, we recommend performing patellar decompression in cases of total knee replacement without patellar resurfacing.     

全膝关节置换术中髌骨置换与髌骨成形对膝关节功能的影响

 目的 探讨髌骨置换与髌骨成形对全膝关节置换术后膝关节功能的影响。方法 对2010年8月至11月拟行全膝关节置换术的48例(69膝)膝关节骨关节炎患者进行随机分组,髌骨置换组24例(35膝)、髌骨成形组24例(34膝)。两组患者年龄、体重、身高、体重指数、美国膝关节协会(Knee Society Score,KSS)膝评分及功能评分、髌骨评分的差异均无统计学意义。比较两组术后6周、3个月、6个月、12个月、24个月的KSS膝评分及功能评分、髌骨评分、术后膝前痛发生率及影像学表现。结果 髌骨置换组20例(30膝)与髌骨成形组20例(29膝)获得随访。术后各时点两组KSS膝评分的差异无统计学意义;6个月以后髌骨置换组KSS功能评分高于髌骨成形组,12个月以后髌骨置换组髌骨评分高于髌骨成形组,差异有统计学意义。术后各时点髌骨置换组膝前痛发生率与髌骨成形组的差异有统计学意义。术后24个月髌骨置换组与髌骨成形组术后胫股角(174.25°±0.97°与173.63°±0.48°)、髌韧带比值(1.01±0.09与1.09±0.07)、髌骨倾斜角(4.58°±0.18°与4.41°±0.19°)、髌骨适合角(2.69°±4.15°与2.56°±3.72°)、髌骨移位距离[(1.53±1.34) mm与(1.68±1.23) mm]的差异均无统计学意义。结论 全膝关节置换术中行髌骨置换可以改善膝关节和髌骨功能,降低术后膝前痛的发生率。     

Patella resurfacing versus nonresurfacing in total knee arthroplasty: results of a randomized controlled clinical trial at a minimum of 10 years' followup

Patellar resurfacing in total knee arthroplasty remains controversial. This study evaluates the results of resurfacing and nonresurfacing the patella in a randomized controlled, clinical trial at a minimum of 10 years followup. One hundred knees (90 patients) with osteoarthritis were enrolled in a prospective randomized clinical trial using a posterior-cruciate-retaining total knee arthroplasty. Patients were randomized to receive resurfacing or retention of the patella. Evaluations were done preoperatively and yearly, up to a minimum of 10 years (range, 10.1-11.5 years) postoperatively. Disease-specific (Knee Society clinical rating score) and functional (stair climbing, flexion/extension torques, patellar examination) outcomes were measured. Patient satisfaction, anterior knee pain, and patellofemoral questionnaires were completed. Intraoperative grading of the articular cartilage was done. No patients were lost to followup; 45 patients remained alive. Nine revisions (in nine of 90 knees; 10%) were done in seven patients in the nonresurfaced group (15% of knees) and in two patients in the resurfaced group (5% of knees). No significant difference was found between the groups regarding revision rates, Knee Society clinical rating scores, and functional, patient satisfaction, anterior knee pain, patellofemoral, and radiographic outcomes. Intraoperative cartilage quality was not a predictor of outcome. This study currently is the longest followup of a randomized controlled, clinical trial that examines patellar resurfacing in total knee arthroplasty. The results showed no significant difference between the groups for all outcome measures at a minimum of 10 years of followup.     

Selective patellar nonresurfacing in total knee arthroplasty. 10 year results.

Patella nonresurfacing in total knee arthroplasty was reviewed retrospectively in 49 knees (42 patients). Thirteen patients (17 knees) died leaving 29 patients (32 knees) in the final study group. The minimum length of followup was 10 years and averaged 11.7 years (range, 10-13.4 years). The diagnosis was primary osteoarthritis in 26 knees, posttraumatic arthritis in four, osteonecrosis in one, and Paget's disease in one. Patients were evaluated using the Knee Society score, a patella score, and radiographs. The mean Knee Society score improved from 52.8 to 87.5 points postoperatively and functional score improved from 57.5 to 84.5 points postoperatively. Anterior knee pain was reported in six knees (20%). Only one patient required secondary resurfacing of the patella because of postoperative anterior knee pain. No significant correlation was found between anterior knee pain and patellofemoral joint space, patellar sclerosis, Insall-Salvati ratio, patellar tilt, gender, obesity, or age. Based on the need for secondary patellar resurfacing because of anterior knee pain, the 10-year survival was 97.5%. At minimum 10-year followup, retaining the patella in total knee arthroplasty in selected patients with osteoarthritis of the osteoarthritic knee can yield acceptable results.     

髌骨软骨退变分级对保留髌骨型全膝关节置换术疗效的影响

 目的 探讨髌骨软骨退变Outerbridge分级对保留髌骨型全膝关节置换术疗效的影响。方法 对2007年2月至2010年1月因膝关节退变性骨关节炎行保留髌骨型全膝关节置换术的151例进行回顾性分析。男65例,女86例;年龄56～82岁,平均(65±5.0)岁。随访时间2～5年,平均3.5年。术中对髌骨软骨退变分级的评定采用Outerbridge标准,统计末次随访时不同髌骨软骨退变分级患者的满意度及膝前痛发生情况,视觉模拟评分(visual analogue scale,VAS)>3分判定为有膝前痛;比较不同髌骨软骨退变分级患者的美国膝关节学会评分(Knee Society Scale,KSS)及髌骨评分。结果 OuterbridgeⅠ级18例、Ⅱ级36例、Ⅲ级62例、Ⅳ级35例。膝前痛发生率4.0%(6/151),其中轻度疼痛4例、中度2例。无翻修病例,总体满意率96.7%(146/151)。不同髌骨软骨退变分级患者的满意度(H=5.54,P=0.14)、膝前痛发生率(H=0.56, P=0.91)、KSS膝评分(F=1.95, P=0.12)、功能评分(F=2.11,P=0.10)及髌骨评分(F=1.35, P=0.26)的差异均无统计学意义。结论 不同髌骨软骨退变分级患者行保留髌骨型全膝关节置换术后疗效无差异,对退变性骨关节炎患者行全膝关节置换术时无须置换髌骨。     

Total knee replacement with and without patellar resurfacing: a prospective, randomised trial using the profix total knee system.

We have examined the differences in clinical outcome of total knee replacement (TKR) with and without patellar resurfacing in a prospective, randomised study of 181 osteoarthritic knees in 142 patients using the Profix total knee system which has a femoral component with features considered to be anatomical and a domed patellar implant. The procedures were carried out between February 1998 and November 2002. A total of 159 TKRs in 142 patients were available for review at a mean of four years (3 to 7). The patients and the clinical evaluator were blinded in this prospective study. Evaluation was undertaken annually by an independent observer using the knee pain scale and the Knee Society clinical rating system. Specific evaluation of anterior knee pain, stair-climbing and rising from a seated to a standing position was also undertaken. No benefit was shown of TKR with patellar resurfacing over that without resurfacing with respect to any of the measured outcomes. In 22 of 73 knees (30.1%) with and 18 of 86 knees (20.9%) without patellar resurfacing there was some degree of anterior knee pain (p = 0.183). No revisions related to the patellofemoral joint were performed in either group. Only one TKR in each group underwent a re-operation related to the patellofemoral joint. A significant association between knee flexion contracture and anterior knee pain was observed in those knees with patellar resurfacing (p = 0.006).     

Patellar resurfacing in total knee arthroplasty: functional outcome differs with different outcome scores: A randomized,double-blind study of 129 knees with 3 years of follow-up

Background and purpose — Recent research on outcomes after total knee arthroplasty (TKA) has raised the question of the ability of traditional outcome measures to distinguish between treatments. We compared functional outcomes in patients undergoing TKA with and without patellar resurfacing, using the knee injury and osteoarthritis outcome score (KOOS) as the primary outcome and 3 traditional outcome measures as secondary outcomes.

Patients and methods — 129 knees in 115 patients (mean age 70 (42–82) years; 67 female) were evaluated in this single-center, randomized, double-blind study. Data were recorded preoperatively, at 1 year, and at 3 years, and were assessed using repeated-measures mixed models.

Results — The mean subscores for the KOOS after surgery were statistically significantly in favor of patellar resurfacing: sport/recreation, knee-related quality of life, pain, and symptoms. No statistically significant differences between the groups were observed with the Knee Society clinical rating system, with the Oxford knee score, and with visual analog scale (VAS) for patient satisfaction.

Interpretation — In the present study, the KOOS—but no other outcome measure used—indicated that patellar resurfacing may be beneficial in TKA.     

Adding Patella Resurfacing After Circumpatellar Electrocautery Did Not Improve the Clinical Outcome in Bilateral Total Knee Arthroplasty in Chinese Population: A Prospective Randomized Study

Background

In total knee arthroplasty (TKA), handling of the patella surface is still quite controversial. We carried out a prospective randomized study to compare circumpatellar electrocautery plus patella resurfacing vs circumpatellar electrocautery only in the single-staged bilateral TKA in Chinese population.

Evidence in orthopaedics: patellar resurfacing in total knee arthroplasty

Abstract 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 Societys 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.     

Patellar resurfacing in total knee arthroplasty leads to better isokinetic performance

BackgroundFor 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.MethodsA 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.ResultsThe 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.ConclusionsThe 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 evidenceLevel I, therapeutic study.