Download PDF
J Knee Surg 2025; 38(03): 122-129
DOI: 10.1055/a-2468-6289
Special Focus Section

Leaving the Patella Unresurfaced Does Not Increase the Risk of Short-Term Revision Following Total Knee Arthroplasty: An Analysis from the American Joint Replacement Registry

Authors

  • Dencel A. García Vélez

    1   Department of Orthopaedic Surgery, The John Hopkins University, Baltimore, Maryland

  • Anirudh Buddhiraju

    1   Department of Orthopaedic Surgery, The John Hopkins University, Baltimore, Maryland

  • Ryland Kagan

    4   Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon

  • Isabella Zaniletti

    2   American Academy of Orthopaedic Surgeons, Combined Analytics Team, Registries and Quality, Rosemont, Illinois

  • Ayushmita De

    2   American Academy of Orthopaedic Surgeons, Combined Analytics Team, Registries and Quality, Rosemont, Illinois

  • Harpal S. Khanuja

    1   Department of Orthopaedic Surgery, The John Hopkins University, Baltimore, Maryland

  • Christopher E. Pelt

    3   Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah

  • Vishal Hegde 

    1   Department of Orthopaedic Surgery, The John Hopkins University, Baltimore, Maryland

Funding The authors received no financial support for the research, authorship, and/or publication of this article.
Further Information
  Permissions and Reprints

Abstract

The benefit of patellar resurfacing in total knee arthroplasty (TKA) remains uncertain, with conflicting evidence regarding associated revision rates and clinical outcomes. Although initial studies have reported higher revision rates associated with unresurfaced patellae, recent evidence questions the necessity of routine patellar resurfacing. This study aimed to evaluate the risk of revision following TKA performed with and without patellar resurfacing using data from the American Joint Replacement Registry (AJRR).

The AJRR was queried for all patients aged 65 years and older undergoing elective TKA between January 2012 and March 2020 with a minimum 2-year follow-up. Cases were linked using supplemental Centers for Medicare and Medicaid data. Cases with hybrid fixation, highly constrained implants, and revision components were excluded. Patients were categorized into two groups: those with a resurfaced patella and those without. Cumulative incidence function (CIF) curves and cause-specific Cox models were utilized to assess all-cause revision risk, adjusting for sex, age, femoral design (cruciate retaining vs. posterior stabilized), fixation type (cemented vs. cementless), and Charlson Comorbidity Index.

Of the 390,304 TKAs with minimum 2-year follow-up in our cohort, 22,829 had no patellar resurfacing performed. Adjusted hazard ratios (HRs) revealed no significant difference in all-cause revision (HR = 0.96, 95% confidence interval [CI]: 0.81–1.13, p = 0.656), revision for mechanical loosening (HR = 1.61 [0.88, 2.93], p = 0.122), or revision for infection (HR = 1.02 [0.79, 1.33], p = 0.860) associated with patellar resurfacing status.

Our study found that patients with an unresurfaced patella do not face an increased short-term revision risk following TKA. These findings challenge the necessity of routine patellar resurfacing and underscore the importance of considering other factors, such as femoral design, patient comorbidities, and implant-related variables in revision risk stratification.

Keywords

total knee replacement - patellar resurfacing - revision total knee replacement - American Joint Replacement Registry

Note

The study was exempt from institutional review board approval.




Publication History

Received: 06 September 2024

Accepted: 13 November 2024

Accepted Manuscript online:
14 November 2024

Article published online:
02 December 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA