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Do Implant-Specific Associations Exist Between Patellar Resurfacing and All-Cause Revision Risk After Primary Total
Bailey J Ross1, Emilio Arellano1, Max McCall1
1Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia.
Background:
The role of patellar resurfacing during primary total knee arthroplasty (TKA) remains controversial. It is unclear if patellar resurfacing impacts revision risk differently across implant systems. The purpose of this study was to compare estimated revision rates for highly utilized TKA implants based on the presence or absence of primary patellar resurfacing.
Methods:
Over 20 national joint registries were screened. Only the National Joint Registry (NJR) Annual Report 2023 and the Endoprothesenregister Deutschland (EPRD) Annual Report 2023 reported implant-specific estimated all-cause revision rates stratified by primary patellar resurfacing status. Individual implants at or above the 50th percentile with respect to implant utilization were analyzed. Kaplan-Meier estimated all-cause revision rates at three and 5 years were compared for individual implants among patients who had versus those who did not have patellar resurfacing during primary TKA using multivariable logistic regression.
Results:
There were 13 unique implant systems from EPRD and 46 implants from NJR that were analyzed, yielding 1,379,573 primary TKAs in total. In the EPRD, estimated all-cause revision rates were significantly higher without primary patellar resurfacing for 58.3% of implants (all odds ratios (ORs) > 1.00, P < 0.05), comparable for 34.0% of implants (P > 0.05), and significantly lower for 7.7% of implants (OR 0.66, P < 0.05). In the NJR, estimated all-cause revision rates were significantly higher without primary patellar resurfacing for 56.5% of implants (all OR > 1.00, P < 0.05), comparable for 41.3% of implants (P > 0.05), and significantly lower for 2.2% of implants (OR 0.91, P < 0.05).
Conclusions:
Across two national joint registries, patellar resurfacing during primary TKA was associated with significantly lower estimated all-cause revision rates at three and five years for over half of the unique implant systems. These data suggest the impact of patellar resurfacing on revision rates may vary based on the implant utilized.
