AAHKS Surgical Techniques & Technologies Award: Resurfacing the Thin Native Patella: Is It Safe?

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Clinical Outcomes Research

Background:

• The decision to resurface the patella during total knee arthroplasty (TKA) is debated, with patellar thickness being a key consideration.
• Concerns exist regarding the adequacy of thin native patellas for resurfacing in TKA procedures.

Purpose of the Study:

• To evaluate implant survivorship, reoperations, complications, and clinical outcomes following patellar resurfacing in TKA patients with thin native patellas.
• To provide evidence-based insights into the safety and efficacy of resurfacing thin patellas during TKA.

Main Methods:

• A retrospective review of 7,477 primary TKA patients (2000-2010) with intraoperatively measured patellar thickness ≤19 mm.
• Analysis of implant survivorship, reoperation rates, complication incidence, and functional scores (Knee Society Score) at a median 10-year follow-up.

Main Results:

• At 10 years, survivorship free from patella revision was 98%, with 98% free from patella-related reoperation and 99% free from periprosthetic patella fracture.
• Complications included 3 patella revisions (1 aseptic loosening, 2 infections) and 2 reoperations for patellar clunk; 3 nonoperative fractures occurred.
• Knee Society Scores significantly improved from a mean of 36 preoperatively to 81 at 10-year follow-up.

Conclusions:

• Patellar resurfacing in TKA for thin native patellas demonstrates high survivorship and improved functional outcomes at 10 years.
• While risks like loosening and fracture exist, they must be balanced against the higher revision rates associated with not resurfacing thin patellas.