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 Adult Knee Reconstruction Test 2: Primary Total Knee Arthroplasty
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The Journal of Bone and Joint Surgery (American) 85:212-217 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Patellar Resurfacing in Total Knee Arthroplasty

A Prospective, Randomized Study

T. S. Waters, MRCS and G. Bentley, ChM, FRCS

Investigation performed at The Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom

T.S. Waters, MRCS
G. Bentley, ChM, FRCS
Institute of Orthopaedics, The Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for T.S. Waters: mail{at}timwaters.com

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Johnson and Johnson. 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.

Background: Anterior knee pain following total knee arthroplasty is a common complaint and typically is attributed to the patellofemoral joint. The purpose of the present study was to compare the outcome of resurfacing and nonresurfacing of the patella, particularly with regard to anterior knee pain, and to clarify the indications for patellar resurfacing at the time of total knee arthroplasty.

Methods: We performed a prospective, randomized study of 514 consecutive primary press-fit condylar total knee replacements. The patients were randomized to either resurfacing or retention of the patella. They were also randomized to either a cruciate-substituting or a cruciate-retaining prosthesis as part of a separate trial. The mean duration of follow-up was 5.3 years (range, two to 8.5 years), and the patients were assessed with use of the Knee Society rating, a clinical anterior knee pain score, and the British Orthopaedic Association patient-satisfaction score. The assessment was performed without the examiner knowing whether the patella had been resurfaced. At the time of follow-up, there were 474 knees. Thirty-five patients who had a bilateral knee replacement underwent resurfacing on one side only.

Results: The overall prevalence of anterior knee pain was 25.1% (fifty-eight of 231 knees) in the nonresurfacing group, compared with 5.3% (thirteen of 243 knees) in the resurfacing group (p < 0.0001). There was one case of component loosening. Ten of eleven patients who underwent secondary resurfacing had complete relief of anterior knee pain. The overall postoperative knee scores were lower in the nonresurfacing group, and the difference was significant among patients with osteoarthritis (p < 0.01). There was no significant difference between the resurfacing and nonresurfacing groups with regard to the postoperative function score. Patients who had a bilateral knee replacement were more likely to prefer the resurfaced side.

Conclusions: As the present study showed a significantly higher rate of anterior knee pain following arthroplasty without patellar resurfacing, we recommend patellar resurfacing at the time of total knee replacement when technically possible.

Level of Evidence: Therapeutic study, Level I-1a (Randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.



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