Revision surgery for patellofemoral problems: should we always resurface?

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Arthroplasty research

Background:

• The utility of routine patellar resurfacing in total knee arthroplasty (TKA) is debated.
• Evidence suggests benefits in both tricompartmental and bicompartmental knee arthroplasty.
• Implant survival rates between approaches remain unclear.

Purpose of the Study:

• To compare cumulative revision rates between routine patellar resurfacing in TKAs and bicompartmental knee arthroplasties.
• To evaluate if patella-friendly implants reduce revision rates compared to earlier designs.
• To assess revision rates for bicompartmental knee arthroplasties later converted to TKAs versus primary TKAs.

Main Methods:

• Analysis of a community joint registry including 8135 patients and 9530 TKAs with patellar resurfacing and 627 bicompartmental knee arthroplasties without patellar resurfacing.
• Comparison of demographic, procedural, and revision data.
• Statistical adjustment for age in revision rate analysis.

Main Results:

• TKAs demonstrated significantly lower cumulative revision rates for patella-only revisions (0.8%) versus bicompartmental knee arthroplasties (4.8%).
• Bicompartmental knee arthroplasties were 6.9 times more likely to require patellar revision than TKAs.
• No significant difference in revision rates was found between patella-friendly and earlier implant designs.
• Secondary patella resurfacing after bicompartmental knee arthroplasty had a higher cumulative revision rate (12.7%) than primary TKAs (6.3%).

Conclusions:

• Bicompartmental knee arthroplasties exhibit higher revision rates than TKAs.
• Femoral component design did not impact cumulative revision rates.
• Performing secondary patella resurfacing carries an increased revision risk compared to resurfacing during the index TKA.
• Routine patellar resurfacing during the initial TKA is recommended to decrease the likelihood of reoperation for patellofemoral issues.