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J Knee Surg
DOI: 10.1055/a-2530-7953
Special Focus Section

Effect of Resurfaced Patellar Thickness on Outcomes after Total Knee Arthroplasty

Siddhartha Dandamudi 
1   Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois
,
Viktor Tollemar
1   Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois
,
Jonathan Spaan
1   Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois
,
Ashwinee Manivannan
1   Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois
,
Brett R. Levine
2   Department of Orthopaedics, MedStar Georgetown University Hospital, Washington, DC
› Author Affiliations
Funding None.
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Abstract

Total knee arthroplasty (TKA) is the gold standard for the treatment of end-stage knee osteoarthritis. Patellar resurfacing is an optional step in the procedure and remains a controversial topic of discussion. This retrospective study aims to assess the impact of over-resecting and under-resecting the patella during resurfacing on patient-reported outcomes and range of motion (ROM) after surgery. Out of 475 patients who underwent TKA between August 2017 and November 2019 at a single center by a single surgeon, 438 (92.2%) were included in the analysis. Patients were split into three study groups based on reconstructed patellar thickness; normal resection (NR) was defined as within 2 mm native thickness, over-resected was defined as ≤ −2 mm, and under-resected (UR) was defined as ≥ 2 mm. Statistical analyses included chi-squared tests, mixed effect models, and Cox proportional hazards models. There were 364, 41, and 33 patients in the NR, OR, and UR groups, respectively. The cohort's mean age at the time of surgery was 67.1 ± 9.1 and had a mean length of follow-up of 2.1 ± 1.7 years with no difference among cohorts. Significant differences were found in gender (p < 0.001) and BMI (p = 0.0134) with UR having fewer males, OR having more males, and OR having lower BMI. At 6 months, the complete cohort ROM improved from 108.7 ± 14.4 to 111 ± 11 degrees, objective knee society score (KSS) increased from 15.4 ± 11.2 to 36.2 ± 12, functional KSS increase from 47.3 ± 18.9 to 65.6 ± 22.2, and knee injury and osteoarthritis outcome score increase from 46.1 ± 15 to 70.7 ± 15 with no significant differences among cohorts. There were no patellofemoral-related complications. This study supports that while it is important to restore the anatomy in the anterior compartment of the knee, minor changes in patellar thickness from patellar resurfacing likely have minimal impact on outcomes for patients. Further studies with a larger sample size are necessary to further validate these findings.

Keywords

total knee arthroplasty - patella resurfacing - patellofemoral joint - patella


Publication History

Received: 29 January 2025

Accepted: 31 January 2025

Accepted Manuscript online:
03 February 2025

Article published online:
24 March 2025

© 2025. Thieme. All rights reserved.

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  • References

  • 1 Maradit Kremers H, Larson DR, Crowson CS. et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am 2015; 97 (17) 1386-1397
    CrossrefPubMedSearch in Google Scholar
  • 2 Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among medicare beneficiaries, 1991-2010. JAMA 2012; 308 (12) 1227-1236
    CrossrefPubMedSearch in Google Scholar
  • 3 Andriacchi TP, Stanwyck TS, Galante JO. Knee biomechanics and total knee replacement. J Arthroplasty 1986; 1 (03) 211-219
    CrossrefPubMedSearch in Google Scholar
  • 4 Abolghasemian M, Samiezadeh S, Sternheim A, Bougherara H, Barnes CL, Backstein DJ. Effect of patellar thickness on knee flexion in total knee arthroplasty: a biomechanical and experimental study. J Arthroplasty 2014; 29 (01) 80-84
    CrossrefPubMedSearch in Google Scholar
  • 5 Petersen W, Rembitzki IV, Brüggemann GP. et al. Anterior knee pain after total knee arthroplasty: a narrative review. Int Orthop 2014; 38 (02) 319-328
    CrossrefPubMedSearch in Google Scholar
  • 6 Fleaca SR, Mohor CI, Dura H. et al. Effect of patella resurfacing on functional outcome and revision rate in primary total knee arthroplasty (Review). Exp Ther Med 2022; 23 (01) 104
    CrossrefPubMedSearch in Google Scholar
  • 7 Heckmann N, Ihn H, Stefl M. et al. Early results from the American joint replacement registry: a comparison with other national registries. J Arthroplasty 2019; 34 (7S): S125 , 134.e1
    CrossrefPubMedSearch in Google Scholar
  • 8 Tammachote N, Kraisin T, Kanitnate S. Do we need to restore patellar thickness after total knee arthroplasty with patellar resurfacing?. Eur J Orthop Surg Traumatol 2023; 33 (08) 3677-3682
    CrossrefPubMedSearch in Google Scholar
  • 9 Adam R, Moldovan C, Tudorache S. et al. Patellar resurfacing in total knee arthroplasty, a never-ending controversy; case report and literature review. Diagnostics (Basel) 2023; 13 (03) 383
    CrossrefPubMedSearch in Google Scholar
  • 10 DeOrio JK, Peden JP. Accuracy of haptic assessment of patellar symmetry in total knee arthroplasty. J Arthroplasty 2004; 19 (05) 629-634
    CrossrefPubMedSearch in Google Scholar
  • 11 Huang AB, Qi YS, Song CH, Zhang JY, Yang YQ, Yu JK. Novel customized template designing for patellar resurfacing in total knee arthroplasty. J Orthop Res 2016; 34 (10) 1798-1803
    CrossrefPubMedSearch in Google Scholar
  • 12 Parke EA, Nakasone CK, Andrews SN, Wright AR, Stickley CD. The effect of patellar thickness on gait biomechanics following total knee arthroplasty. Knee 2019; 26 (06) 1354-1359
    CrossrefPubMedSearch in Google Scholar
  • 13 Helmy N, Anglin C, Greidanus NV, Masri BA. To resurface or not to resurface the patella in total knee arthroplasty. Clin Orthop Relat Res 2008; 466 (11) 2775-2783
    CrossrefPubMedSearch in Google Scholar
  • 14 Hsu HC, Luo ZP, Rand JA, An KN. Influence of patellar thickness on patellar tracking and patellofemoral contact characteristics after total knee arthroplasty. J Arthroplasty 1996; 11 (01) 69-80
    CrossrefPubMedSearch in Google Scholar
  • 15 Yu Z, Cai H, Liu Z. Factors that impact the patellofemoral contact stress in the TKA: a review. Arthroplasty 2023; 5 (01) 44
    CrossrefPubMedSearch in Google Scholar
  • 16 Koh JSB, Yeo SJ, Lee BPH, Lo NN, Seow KH, Tan SK. Influence of patellar thickness on results of total knee arthroplasty: does a residual bony patellar thickness of ≤12 mm lead to poorer clinical outcome and increased complication rates?. J Arthroplasty 2002; 17 (01) 56-61
    CrossrefPubMedSearch in Google Scholar
  • 17 Youm YS, Cho WS, Woo JH, Kim BK. The effect of patellar thickness changes on patellar tilt in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2010; 18 (07) 923-927
    CrossrefPubMedSearch in Google Scholar
  • 18 Ghosh KM, Merican AM, Iranpour F, Deehan DJ, Amis AA. The effect of overstuffing the patellofemoral joint on the extensor retinaculum of the knee. Knee Surg Sports Traumatol Arthrosc 2009; 17 (10) 1211-1216
    CrossrefPubMedSearch in Google Scholar
  • 19 Schiavone Panni A, Cerciello S, Del Regno C, Felici A, Vasso M. Patellar resurfacing complications in total knee arthroplasty. Int Orthop 2014; 38 (02) 313-317
    CrossrefPubMedSearch in Google Scholar
  • 20 Kienzle A, Walter S, Palmowski Y. et al. Influence of gender on occurrence of aseptic loosening and recurrent PJI after revision total knee arthroplasty. Osteology 2021; 1 (02) 92-104
    CrossrefPubMedSearch in Google Scholar
  • 21 Yoon HK, Yoo JH, Oh HC, Ha JW, Park SH. The Incidence rate, microbiological etiology, and results of treatments of prosthetic joint infection following total knee arthroplasty. J Clin Med 2023; 12 (18) 5908
    CrossrefPubMedSearch in Google Scholar
  • 22 Zachwieja E, Perez J, Hardaker WM, Levine B, Sheth N. Manipulation under anesthesia and stiffness after total knee arthroplasty. JBJS Rev 2018; 6 (04) e2
    CrossrefPubMedSearch in Google Scholar
  • 23 Kemp MA, Metcalfe AJ, Sayers A, Wylde V, Eldridge JD, Blom AW. Does overstuffing of the patellofemoral joint in total knee arthroplasty have a significant effect on postoperative outcomes?. Knee 2018; 25 (05) 874-881
    CrossrefPubMedSearch in Google Scholar
  • 24 Bengs BC, Scott RD. The effect of patellar thickness on intraoperative knee flexion and patellar tracking in total knee arthroplasty. J Arthroplasty 2006; 21 (05) 650-655
    CrossrefPubMedSearch in Google Scholar
  • 25 Tanikawa H, Tada M, Ogawa R. et al. Influence of patella thickness on patellofemoral pressure in total knee arthroplasty. BMC Musculoskelet Disord 2021; 22 (01) 298
    CrossrefPubMedSearch in Google Scholar
  • 26 Faber SC, Eckstein F, Lukasz S. et al. Gender differences in knee joint cartilage thickness, volume and articular surface areas: assessment with quantitative three-dimensional MR imaging. Skeletal Radiol 2001; 30 (03) 144-150
    CrossrefPubMedSearch in Google Scholar
  • 27 Baldwin JL, House CK. Anatomic dimensions of the patella measured during total knee arthroplasty. J Arthroplasty 2005; 20 (02) 250-257
    CrossrefPubMedSearch in Google Scholar