Should the patella be replaced in total knee replacement?

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Arthroplasty Research

Background:

• Osteoarthritis commonly necessitates total knee arthroplasty (TKA).
• The patellar component in TKA remains a subject of debate regarding optimal surgical technique and patient outcomes.
• Assessing the impact of patellar resurfacing versus non-resurfacing is crucial for improving TKA procedures.

Purpose of the Study:

• To compare clinical and radiological outcomes of TKAs performed with and without patellar replacement.
• To evaluate the incidence of symptomatic patellar non-congruency and revision rates between the two surgical approaches.

Main Methods:

• A retrospective study of 170 total knee arthroplasties for osteoarthritis.
• Group A: 71 knees without patellar replacement; Group B: 99 knees with cemented polyethylene patellar replacement.
• Follow-up averaged 36 months, assessing radiological patellar congruency, HSS scores, and patellar scores.

Main Results:

• Radiological patellar congruency was similar between groups (21 non-congruent knees in each).
• Group A had significantly more symptomatic non-congruent knees (8) compared to Group B (2) (P<0.05).
• Mean Hospital for Special Surgery (HSS) and patellar scores were significantly higher in Group B (patellar replacement) than in Group A (P<0.05).

Conclusions:

• Cemented polyethylene patellar replacement in TKA is associated with better functional outcomes and lower rates of symptomatic patellar non-congruency compared to non-replacement.
• Patellar resurfacing should be considered in TKA for osteoarthritis to improve patient satisfaction and functional recovery.