Postoperative knee pain, satisfaction, and revision after total knee arthroplasty with and without primary patella...

Patella resurfacing during total knee arthroplasty (TKA) remains controversial. We performed a large cohort study to assess pain, function, and revision risk between patients with and without primary patella resurfacing.

We identified 10,846 primary TKAs in 2005-2024. We ascertained patella-related pain and function from Oxford knee score questions and patient satisfaction at year one and two. We used logistic regression to estimate the association between patella status and these outcomes. We identified revision TKA and used Cox proportional hazard models to estimate its association with patella resurfacing.

Around 78 % of patients had primary patella resurfacing during their TKA, 96 % of resurfaced patellas were done with a posterior-stabilized knee system versus 48 % of unresurfaced patellas. We observed no difference in patella-related pain and function by patella status. Patella-related pain had an adjusted odds ratio [OR] of 0.94 (95 % confidence interval [CI] 0.79-1.12) for resurfaced patellas at year one, the OR for patella-related functional issues was 0.98 (95 % CI 0.78-1.22). The hazard ratio for five years of follow up for revision was 0.75 (95 % CI 0.50-1.12).

Patients with and without primary patella resurfacing had similar patella-related pain and functional outcomes in the first two postoperative years. Unresurfaced patellas had higher revision rates, although this was not statistically significant. A small subset of patients with unresurfaced patellas may have unfavorable outcomes, but these patients may also have been revised in an attempt to reduce anterior knee pain that would have been present with primary patella resurfacing.