Why Patella Resurfacing Is the Right Choice
At ICJR’s Pan Pacific Orthopaedic Congress, Dr. Fred Cushner spoke on the use of patella resurfacing during total knee arthroplasty. Following is his abstract for the presentation.
By Fred D. Cushner, MD
Orthopedic surgeons like to debate the finer points of surgical technique. Topics such as how to handle the PCL, ideal DVT prophylaxis method, and favorite prosthesis may not have a clear debate winner, but that is not true for the debate surrounding patella resurfacing.
Resurfacing the patella is clearly the correct choice for the following reasons:
1. Do we really believe that cartilage on metal is a good long-term bearing surface? Is this the type of bearing surfaces we want in the current total knee arthroplasty (TKA) population that is younger and heavier than patients in the past?
2. The cartilage at the patella is not normal. A recent study showed that even a “normal“ patella has significant pathologic changes.
3. Anterior knee pain is common following TKA in all patients and significantly increased in the obese patient. How can we distinguish anterior knee pain from pain from an unresurfaced patella?
4. Second operations to resurface a patella are often unsuccessful.
5. The patella complication rate from resurfacing is low, with several studies showing a 1% incidence.
6. All prosthesis designs are not created equal. A patella-friendly design is needed if patella resurfacing is not performed. Successful results of a study of one type of design do not mean successful results with another type of design.
7. Meta-analysis results show higher revision rates with unresurfaced designs.
8. Parvizi et al found less patient satisfaction with an unresurfaced patella.
9. Pakos et al found fewer reoperations and less anterior knee pain with resurfacing.
10. Does select resurfacing make sense for young patients? Do we want them to have cartilage on metal in patients who will have a prosthesis for the next 20 to 30 years?
11. More bilateral knee studies favor the resurfaced knee.
12. Swedish registry data show a 1.4 times higher revision rate with no patella resurfacing.
So what are we trying to fix? Patella complications are rare and most studies, meta-analysis reviews, and registry data favor patella resurfacing.
Dr. Cushner’s presentation from the Pan Pacific Orthopaedic Congress can be found here.
Fred D. Cushner, MD, is from Northshore-LIJ Orthopaedic Institute, New York, New York.