Effect of Resurfaced Patellar Thickness on Outcomes after Total Knee Arthroplasty

Abstract

Total knee arthroplasty (TKA) is the gold standard for the treatment of end-stage knee osteoarthritis. Patellar resurfacing is an optional step in the procedure and remains a controversial topic of discussion. This retrospective study aims to assess the impact of over-resecting and under-resecting the patella during resurfacing on patient-reported outcomes and range of motion (ROM) after surgery. Out of 475 patients who underwent TKA between August 2017 and November 2019 at a single center by a single surgeon, 438 (92.2%) were included in the analysis. Patients were split into three study groups based on reconstructed patellar thickness; normal resection (NR) was defined as within 2 mm native thickness, over-resected was defined as ≤ −2 mm, and under-resected (UR) was defined as ≥ 2 mm. Statistical analyses included chi-squared tests, mixed effect models, and Cox proportional hazards models. There were 364, 41, and 33 patients in the NR, OR, and UR groups, respectively. The cohort's mean age at the time of surgery was 67.1 ± 9.1 and had a mean length of follow-up of 2.1 ± 1.7 years with no difference among cohorts. Significant differences were found in gender (p < 0.001) and BMI (p = 0.0134) with UR having fewer males, OR having more males, and OR having lower BMI. At 6 months, the complete cohort ROM improved from 108.7 ± 14.4 to 111 ± 11 degrees, objective knee society score (KSS) increased from 15.4 ± 11.2 to 36.2 ± 12, functional KSS increase from 47.3 ± 18.9 to 65.6 ± 22.2, and knee injury and osteoarthritis outcome score increase from 46.1 ± 15 to 70.7 ± 15 with no significant differences among cohorts. There were no patellofemoral-related complications. This study supports that while it is important to restore the anatomy in the anterior compartment of the knee, minor changes in patellar thickness from patellar resurfacing likely have minimal impact on outcomes for patients. Further studies with a larger sample size are necessary to further validate these findings.

Keywords

total knee arthroplasty - patella resurfacing - patellofemoral joint - patella

Publication History

Received: 29 January 2025

Accepted: 31 January 2025

Accepted Manuscript online:
03 February 2025

Article published online:
24 March 2025

• References

• 1 Maradit Kremers H, Larson DR, Crowson CS. et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am 2015; 97 (17) 1386-1397
• 2 Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among medicare beneficiaries, 1991-2010. JAMA 2012; 308 (12) 1227-1236
• 3 Andriacchi TP, Stanwyck TS, Galante JO. Knee biomechanics and total knee replacement. J Arthroplasty 1986; 1 (03) 211-219
• 4 Abolghasemian M, Samiezadeh S, Sternheim A, Bougherara H, Barnes CL, Backstein DJ. Effect of patellar thickness on knee flexion in total knee arthroplasty: a biomechanical and experimental study. J Arthroplasty 2014; 29 (01) 80-84
• 5 Petersen W, Rembitzki IV, Brüggemann GP. et al. Anterior knee pain after total knee arthroplasty: a narrative review. Int Orthop 2014; 38 (02) 319-328
• 6 Fleaca SR, Mohor CI, Dura H. et al. Effect of patella resurfacing on functional outcome and revision rate in primary total knee arthroplasty (Review). Exp Ther Med 2022; 23 (01) 104
• 7 Heckmann N, Ihn H, Stefl M. et al. Early results from the American joint replacement registry: a comparison with other national registries. J Arthroplasty 2019; 34 (7S): S125 , 134.e1
• 8 Tammachote N, Kraisin T, Kanitnate S. Do we need to restore patellar thickness after total knee arthroplasty with patellar resurfacing?. Eur J Orthop Surg Traumatol 2023; 33 (08) 3677-3682
• 9 Adam R, Moldovan C, Tudorache S. et al. Patellar resurfacing in total knee arthroplasty, a never-ending controversy; case report and literature review. Diagnostics (Basel) 2023; 13 (03) 383
• 10 DeOrio JK, Peden JP. Accuracy of haptic assessment of patellar symmetry in total knee arthroplasty. J Arthroplasty 2004; 19 (05) 629-634
• 11 Huang AB, Qi YS, Song CH, Zhang JY, Yang YQ, Yu JK. Novel customized template designing for patellar resurfacing in total knee arthroplasty. J Orthop Res 2016; 34 (10) 1798-1803
• 12 Parke EA, Nakasone CK, Andrews SN, Wright AR, Stickley CD. The effect of patellar thickness on gait biomechanics following total knee arthroplasty. Knee 2019; 26 (06) 1354-1359
• 13 Helmy N, Anglin C, Greidanus NV, Masri BA. To resurface or not to resurface the patella in total knee arthroplasty. Clin Orthop Relat Res 2008; 466 (11) 2775-2783
• 14 Hsu HC, Luo ZP, Rand JA, An KN. Influence of patellar thickness on patellar tracking and patellofemoral contact characteristics after total knee arthroplasty. J Arthroplasty 1996; 11 (01) 69-80
• 15 Yu Z, Cai H, Liu Z. Factors that impact the patellofemoral contact stress in the TKA: a review. Arthroplasty 2023; 5 (01) 44
• 16 Koh JSB, Yeo SJ, Lee BPH, Lo NN, Seow KH, Tan SK. Influence of patellar thickness on results of total knee arthroplasty: does a residual bony patellar thickness of ≤12 mm lead to poorer clinical outcome and increased complication rates?. J Arthroplasty 2002; 17 (01) 56-61
• 17 Youm YS, Cho WS, Woo JH, Kim BK. The effect of patellar thickness changes on patellar tilt in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2010; 18 (07) 923-927
• 18 Ghosh KM, Merican AM, Iranpour F, Deehan DJ, Amis AA. The effect of overstuffing the patellofemoral joint on the extensor retinaculum of the knee. Knee Surg Sports Traumatol Arthrosc 2009; 17 (10) 1211-1216
• 19 Schiavone Panni A, Cerciello S, Del Regno C, Felici A, Vasso M. Patellar resurfacing complications in total knee arthroplasty. Int Orthop 2014; 38 (02) 313-317
• 20 Kienzle A, Walter S, Palmowski Y. et al. Influence of gender on occurrence of aseptic loosening and recurrent PJI after revision total knee arthroplasty. Osteology 2021; 1 (02) 92-104
• 21 Yoon HK, Yoo JH, Oh HC, Ha JW, Park SH. The Incidence rate, microbiological etiology, and results of treatments of prosthetic joint infection following total knee arthroplasty. J Clin Med 2023; 12 (18) 5908
• 22 Zachwieja E, Perez J, Hardaker WM, Levine B, Sheth N. Manipulation under anesthesia and stiffness after total knee arthroplasty. JBJS Rev 2018; 6 (04) e2
• 23 Kemp MA, Metcalfe AJ, Sayers A, Wylde V, Eldridge JD, Blom AW. Does overstuffing of the patellofemoral joint in total knee arthroplasty have a significant effect on postoperative outcomes?. Knee 2018; 25 (05) 874-881
• 24 Bengs BC, Scott RD. The effect of patellar thickness on intraoperative knee flexion and patellar tracking in total knee arthroplasty. J Arthroplasty 2006; 21 (05) 650-655
• 25 Tanikawa H, Tada M, Ogawa R. et al. Influence of patella thickness on patellofemoral pressure in total knee arthroplasty. BMC Musculoskelet Disord 2021; 22 (01) 298
• 26 Faber SC, Eckstein F, Lukasz S. et al. Gender differences in knee joint cartilage thickness, volume and articular surface areas: assessment with quantitative three-dimensional MR imaging. Skeletal Radiol 2001; 30 (03) 144-150
• 27 Baldwin JL, House CK. Anatomic dimensions of the patella measured during total knee arthroplasty. J Arthroplasty 2005; 20 (02) 250-257