Comparison of patellar retention versus resurfacing in LCS mobile-bearing total knee arthroplasty

The aim of this retrospective study was to compare clinical outcomes of total knee arthroplasty (TKA) with and without patellar resurfacing using the Low Contact Stress (LCS) mobile-bearing prosthesis in 275 osteoarthritic knees (199 patients) after a minimum of 7 years of follow-up.

Patients were divided into a patellar retention group (132 knees) and a resurfacing group (143 knees), with median follow-up durations of 7.8 years (range, 7-8.5 years) and 8.5 years (range, 7-10.6 years), respectively. The demographics of the two groups were otherwise matched. The patelloplasty was performed for patellar retention. Patients were evaluated by a blinded, independent observer using Feller's patellar score, the Knee Society score, patient satisfaction, patellar tilt, and lateral displacement.

Patellar resurfacing was not superior to retention with respect to any of the measured variables. Eight knees (6.1%) without and 6 (4.2%) with patellar resurfacing had anterior knee pain related to the patellofemoral joint (n.s.). The reoperation rate related to the patellofemoral joint was 0.8% (n = 1) in the retention group compared with 2.8% (n = 4) in the resurfacing group (n.s.). In the 35 patients who underwent bilateral TKA with patellar resurfacing on only one side, there were no significant differences between the two sides in subjective preference, clinical scores, or functional ability.

The clinical and radiographic outcomes of TKA with the LCS mobile-bearing prosthesis showed no significant difference between the two groups after a minimum of 7 years of follow-up. The findings in this study suggest that patellar retention with a patelloplasty may be viable as a routine procedure, even in knees with advanced patellofemoral arthritis, if soft tissue balancing and a patella-friendly prosthetic design are properly used.

Therapeutic, retrospective, comparative study, Level III.