The Journal of Bone and Joint Surgery (American) 83:1376-1381 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Patellar Resurfacing in Total Knee Arthroplasty
A Prospective, Randomized, Double-Blind Study with Five to Seven Years of Follow-up
Robert L. Barrack, MD,
Alexander J. Bertot, MD,
Michael W. Wolfe, MD,
Douglas A. Waldman, MD,
Matko Milicic, MD and
Leann Myers, PhD
Investigation performed at Tulane University School of Medicine,
New Orleans, Louisiana
Robert L. Barrack, MD
Alexander J. Bertot, MD
Michael W. Wolfe, MD
Department of Orthopaedic Surgery, SL-32, Tulane University School
of Medicine, New Orleans, LA 70112. E-mail address for R.L. Barrack:
rbarrack{at}tulane.edu
Douglas A. Waldman, MD
Orthopaedic Surgery Section, Surgical Service, Veterans Affairs
Medical Center, Shreveport Highway, Alexandria, LA 71302
Matko Milicic, MD
Orthopaedic Surgery Section, Surgical Service, Veterans Affairs
Medical Center, 1601 Perdido Street, New Orleans, LA 70146
Leann Myers, PhD
Department of Biostatistics and Epidemiology, Tulane University
School of Public Health and Tropical Medicine, New Orleans, LA 70112
In support of their research or preparation of this manuscript, one
or more of the authors received research funding from Zimmer, Incorporated.
None of the authors received payments or other benefits or a commitment
or agreement to provide such benefits from a commercial entity.
No commercial entity paid or directed, or agreed to pay or direct,
any benefits to any research fund, foundation, educational institution,
or other charitable or nonprofit organization with which the authors are
affiliated or associated.
A commentary is available with the electronic versions of this article,
on our web site (www.jbjs.org) and on our CD-ROM (call 781-449-9780,
ext. 140, to order).
Background: Whether to resurface the patella
during a primary total knee arthroplasty performed for the treatment
of degenerative osteoarthritis remains a controversial issue. Parameters
that have been suggested as being useful in guiding this decision include
patient height and weight, the presence of anterior knee pain preoperatively,
and the grade of chondromalacia encountered intraoperatively. The
purpose of this study was to determine whether these parameters
were predictive of the clinical result following total knee arthroplasty
with or without patellar resurfacing.
Methods: Eighty-six patients (118 knees) undergoing
primary total knee arthroplasty for the treatment of osteoarthritis
were enrolled in a prospective, randomized, double-blind study.
All patients received the same posterior-cruciate-sparing total knee
prosthetic components. Patients were randomized to treatment with
or without resurfacing of the patella. Evaluations consisted of
the determination of a Knee Society clinical score, the completion
of a patient satisfaction questionnaire, specific questions relating
to patellofemoral symptoms, and radiographs. Sixty-seven patients
(ninety-three knees) were followed for a minimum of five years (range,
sixty to eighty-four months; average, 70.5 months).
Results: With the numbers available, there was no
significant difference between the groups treated with and without
resurfacing with regard to the overall Knee Society score or the
pain and function subscores. Obesity, the degree of patellar chondromalacia,
and the presence of preoperative anterior knee pain did not predict
postoperative clinical scores or the presence of postoperative anterior
knee pain.
Conclusions: The occurrence of anterior knee pain
could not be predicted with any clinical or radiographic parameter
studied. On the basis of these results, it seems likely that postoperative
anterior knee pain is related either to the component design or
to the details of the surgical technique, such as component rotation,
rather than to whether or not the patella is resurfaced.
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