Range of Motion Comparison Following Total Knee Arthroplasty with and without Patella Resurfacing
DOI:
https://doi.org/10.15438/rr.11.1.286Keywords:
range of motion, Total Knee Arthroplasty, patella resurfacingAbstract
Background: Despite significant evaluation, no consensus has been reach for best clinical practice for resurfacing the patella during total knee arthroplasty. Further complicating the ability to reach a conclusion is the inclusion of several different implant types used in previous research.
Questions/Purpose: The purpose of this study was to compare post-TKA outcomes between two cruciate retaining implants with or without patella resurfacing.
Methods: This retrospective review included 289 patients (380 knees) with a minimum six-month follow-up. All patients received a CR implant, with either a symmetric or an asymmetric tibial baseplate. Post-TKA knee flexion was categorized as <120° and ?120° and knee extension classified as 0° or >0° and required knee manipulations were noted. Descriptive, nonparametric statistics were performed and a multivariate logistic regression was performed to determine risk of poor range of motion and manipulations.
Results: Age was significantly lower in the resurfaced group (p=0.001) and the resurfaced group had longer tourniquet time (p=0.003). The symmetric-resurfaced group had ?120° of flexion and full extension in 72% and 98.7% of patients, respectively. Compared to symmetric-resurfaced, all other groups had a significantly greater risk of not reaching 120° of knee flexion (p<0.05). There were no significant differences in the risk of requiring a MUA between groups (p>0.06).
Conclusions: The effect of resurfacing the patella on post-TKA outcomes may be influenced by tibial implant design. Compared to all other combinations, a symmetric tibial baseplate and resurfaced patella resulted in the highest percentage of patients reaching ?120°, with a low incidence of manipulations.
References
Fraser JF and Spangehl MJ. International Rates of Patellar Resurfacing in Primary Total Knee Arthroplasty, 2004-2014. J Arthroplasty 32(1): 83-86, 2017.
Fuchs S, Schutte G, Witte H and Rosenbaum D. Retropatellar contact characteristics in total knee arthroplasty with and without patellar resurfacing. Int Orthop 24(4): 191-193, 2000.
Barink M, Meijerink H, Verdonschot N, van Kampen A and de Waal Malefijt M. Asymmetrical total knee arthroplasty does not improve patella tracking: a study without patella resurfacing. Knee Surg Sports Traumatol Arthrosc 15(2): 184-191, 2007.
Wurm S, Kainz H, Reng W and Augat P. The influence of patellar resurfacing on patellar kinetics and retropatellar contact characteristics. J Orthop Sci 18(1): 61-69, 2013.
Slevin O, Schmid FA, Schiapparelli FF, Rasch H, Amsler F and Hirschmann MT. Coronal femoral TKA position significantly influences in vivo patellar loading in unresurfaced patellae after primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25(11): 3605-3610, 2017.
Matsuda S, Ishinishi T, White SE and Whiteside LA. Patellofemoral joint after total knee arthroplasty. Effect on contact area and contact stress. J Arthroplasty 12(7): 790-797, 1997.
Benjamin JB, Szivek JA, Hammond AS, Kubchandhani Z, Matthews AI, Jr. and Anderson P. Contact areas and pressures between native patellas and prosthetic femoral components. J Arthroplasty 13(6): 693-698, 1998.
Singerman R, Gabriel SM, Maheshwer CB and Kennedy JW. Patellar contact forces with and without patellar resurfacing in total knee arthroplasty. J Arthroplasty 14(5): 603-609, 1999.
Chen K, Li G, Fu D, Yuan C, Zhang Q and Cai Z. Patellar resurfacing versus nonresurfacing in total knee arthroplasty: a meta-analysis of randomised controlled trials. Int Orthop 37(6): 1075-1083, 2013.
Migliorini F, Eschweiler J, Niewiera M, El Mansy Y, Tingart M and Rath B. Better outcomes with patellar resurfacing during primary total knee arthroplasty: a meta-analysis study. Arch Orthop Trauma Surg 139(10): 1445-1454, 2019.
Grassi A, Compagnoni R, Ferrua P, Zaffagnini S, Berruto M, Samuelsson K, Svantesson E and Randelli P. Patellar resurfacing versus patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses. Knee Surg Sports Traumatol Arthrosc 26(11): 3206-3218, 2018.
Nizard RS, Biau D, Porcher R, Ravaud P, Bizot P, Hannouche D and Sedel L. A meta-analysis of patellar replacement in total knee arthroplasty. Clin Orthop Relat Res (432): 196-203, 2005.
Parvizi J, Rapuri VR, Saleh KJ, Kuskowski MA, Sharkey PF and Mont MA. Failure to resurface the patella during total knee arthroplasty may result in more knee pain and secondary surgery. Clin Orthop Relat Res 438: 191-196, 2005.
Teel AJ, Esposito JG, Lanting BA, Howard JL and Schemitsch EH. Patellar Resurfacing in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials. J Arthroplasty 34(12): 3124-3132, 2019.
Lygre SH, Espehaug B, Havelin LI, Vollset SE and Furnes O. Does patella resurfacing really matter? Pain and function in 972 patients after primary total knee arthroplasty. Acta Orthop 81(1): 99-107, 2010.
Maney AJ, Frampton CM and Young SW. Age and Prosthetic Design as Risk Factors for Secondary Patella Resurfacing. J Arthroplasty 35(6): 1563-1568, 2020.
Maney AJ, Koh CK, Frampton CM and Young SW. Usually, Selectively, or Rarely Resurfacing the Patella During Primary Total Knee Arthroplasty: Determining the Best Strategy. J Bone Joint Surg Am 101(5): 412-420, 2019.
Coory JA, Tan KG, Whitehouse SL, Hatton A, Graves SE and Crawford RW. The Outcome of Total Knee Arthroplasty With and Without Patellar Resurfacing up to 17 Years: A Report From the Australian Orthopaedic Association National Joint Replacement Registry. J Arthroplasty 35(1): 132-138, 2020.
van der Merwe JM and Mastel MS. Controversial Topics in Total Knee Arthroplasty: A 5-Year Update (Part 1). J Am Acad Orthop Surg Glob Res Rev 4(1): e1900047, 2020.
Galea VP, Rojanasopondist P, Connelly JW, Bragdon CR, Huddleston JI, 3rd, Ingelsrud LH, Malchau H and Troelsen A. Changes in Patient Satisfaction Following Total Joint Arthroplasty. J Arthroplasty 35(1): 32-38, 2020.
Singh AD. Retrospective study of asymmetric vs symmetric tibial plates and ultracongruent vs posterior stabilized inserts in Indian population: An Indian experience of Natural Knee II. J Clin Orthop Trauma 7(Suppl 2): 184-190, 2016.
Harato K, Yagi M, Fujita N, Kobayashi S, Ohya A, Kaneda K, Iwama Y, Nakamura M and Matsumoto M. Effect of body mass index on surgical times of lumbar laminoplasty and lower limb arthroplasties. BMC Musculoskelet Disord 20(1): 416, 2019.
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Melissa Jackels, Samantha Andrews, Maya Matsumoto, Kristin Mathews, Cass Nakasone

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.