Management of the Patella During Total Knee Arthroplasty

The optimal management of the patella during total knee arthroplasty (TKA) remains a controversial topic with no consensus.

Patellar management techniques during TKA include patellar retention or resurfacing with or without patellaplasty, as well as circumferential denervation and partial lateral facetectomy (PLF).

Special considerations such as patient age, etiology of disease, implant design, and surgeon preference should be accounted for when determining optimal management.

We recommend that most patellae be circumferentially denervated, regardless of whether they are resurfaced, as the potential benefits outweigh the small associated risks.

Evidence demonstrates improved functional outcomes with the addition of PLF to nonresurfaced patellae. There is currently a paucity of evidence of this technique with respect to resurfaced patellae.

Patellar resurfacing adds additional costs and health-care resources that should be considered in the decision-making process.