The Outcome of Total Knee Arthroplasty With and Without Patellar Resurfacing up to 17 Years: A Report From the Australian Orthopaedic Association National Joint Replacement Registry |
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| Institution: | 1. Department of Orthopaedic Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia;2. Orthopaedic Research Unit, Queensland University of Technology (QUT), Brisbane, Australia;3. South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia;4. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, Australia;1. Department of Orthopaedics, Stanford University, Stanford, CA;2. Department of Orthopaedics, University of Iowa Hospitals and Clinics, Iowa City, IA;1. Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH;2. Geisel School of Medicine, Dartmouth College, Hanover, NH;3. Berkley Medical Management Solutions, Overland Park, KS;1. Joint Implant Surgeons, Inc, New Albany, Ohio;2. Mount Carmel Health System, New Albany, Ohio;3. Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio;4. Department of Orthopaedic Surgery, Washington University, Chesterfield, Missouri;1. Lake Erie College of Osteopathic Medicine, Erie, PA;2. Orthopaedic Surgery, BLK Super Specialty Hospital, New Delhi, Delhi, India;3. Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA;4. Virginia Commonwealth University School of Medicine, Richmond, VA;5. Orthopaedic Surgery, Hospital for Special Surgery, New York, NY;1. South West London Elective Orthopaedic Centre, MSK Lab – Imperial College London, Dorking Road, KT18 7EG Epsom, United Kingdom;2. SWLEOC Research centre, Dorking Road, KT18 7EG Epsom, United Kingdom;3. Clinique du Sport, Centre de l’arthrose, 4, rue Georges-Negrevergne, 33700 Mérignac, France;4. Laboratory Block, MSK Lab – Imperial College London, Charing Cross Campus, St Dunstan''s Road, W6 8RP Hammersmith, London United Kingdom;1. Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand;2. Department of Medicine, University of Otago, Christchurch, New Zealand;3. Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand |
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| Abstract: | BackgroundPatellar resurfacing in total knee arthroplasty (TKA) remains a controversial issue after more than 4 decades of TKA. Despite a growing body of evidence from registry data, resurfacing is still based largely on a surgeon’s preference and training. The purpose of this study is to provide long-term outcomes for patellar resurfaced compared to when the patella is not resurfaced.MethodsData from the Australian Orthopaedic Association National Joint Replacement Registry (1999-2017) were used for this study. The analysis included 570,735 primary TKAs undertaken for osteoarthritis. Hazard ratios (HRs) and 17-year cumulative percent revision rates were used to compare revision rates between 4 subgroups: minimally stabilized (MS) patellar resurfacing, posterior stabilized (PS) patellar resurfacing, MS unresurfaced, and PS unresurfaced patella. Additional analyses of the patellar implant type and a comparison of inlay and onlay patellar resurfacing were also performed.ResultsFor all primary TKA, procedures where the patella was not resurfaced have a higher rate of revision compared to procedures where the patella was resurfaced (HR, 1.31; confidence interval, 1.28-1.35; P < .001). Unresurfaced PS knees have the highest cumulative percent revision at 17 years (11.1%), followed by MS unresurfaced (8.8%), PS resurfaced (7.9%), and MS resurfaced (7.1%). Inlay patellar resurfacing has a higher rate of revision compared to onlay patellar resurfacing (HR, 1.27; confidence interval, 1.17-1.37; P < .001).ConclusionResurfacing the patella reduces the rate of revision for both MS and PS knees. MS knees with patellar resurfacing have the lowest rate of revision. Onlay patella designs are associated with a lower revision rate compared to inlay patella designs. |
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| Keywords: | total knee arthroplasty registry outcome revision patellar resurfacing anterior knee pain |
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