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Better outcomes with patellar resurfacing during primary total knee arthroplasty: a meta-analysis study

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Total knee arthroplasty (TKA) is a feasible and cost-effective procedure. However, resurfacing of the patella sparks a heated debate. Anterior knee pain after TKA was supposed to be correlated to the patellofemoral joint, and the resurface of the patella was believed to be effective to avoid this complication.

Aim

A meta-analysis was performed to update current evidence concerning the outcomes of patellar resurfacing versus retaining for total knee arthroplasty. The first outcomes of interest were to compare the rate of anterior knee pain and revision surgeries.

Material and methods

This study was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). A comprehensive review of the literature was conducted accessing the main databases: Embase, Google Scholar, PubMed, Scopus. All the prospective clinical trials comparing the outcomes between patellar resurfacing versus retaining were included in this study. Only articles classified as level of evidence I to II were considered for inclusion. Only studies reporting a minimum 24 months follow-up were included. The following data were extracted: demographic baseline, anterior knee pain, reoperations, clinical scores (HSS, KSS and related subscales) and range of motion (ROM). Studies solely reporting quantitative data under the outcomes of interest were included.

Results

In favor of the resurfacing group, we observed a statistically significant reduced rate of anterior knee pain (odd ratio 1.73) and reoperation (odd ratio 3.24). In the resurfacing group, a prevalence of anterior knee pain of 11.15% was detected, whereas in the retaining group it amounted to 17.39%. Furthermore, a greater KSS pain (+ 0.97%), KSS clinical (+ 0.23%), KSS functional (+ 2.44%), KSS overall (+ 2.47%) and HSS (+ 5.64%) were reported. In the retaining group, we found a better range of motion (+ 3.09°).

Conclusion

Based on the main findings of this meta-analysis, patellar resurfaced TKA was demonstrated to have performed superior overall. Patellar resurfacing detected a lower rate of postoperative anterior knee pain and reoperation. Moreover, the resurfacing group showed greater value of the HSS, KSS and related subscales. In favor of the retaining group, a slightly better ROM was evidenced.

Level of evidence

Level II, meta-analysis of prospective clinical trials

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Acknowledgements

We would like to thank Pia Offermanns B. A. (freelance editor, translator and proof-reader) for her professional editing of this study.

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Authors and Affiliations

  1. Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany

    Filippo Migliorini, Jörg Eschweiler, Yasser El Mansy, Markus Tingart & Björn Rath

  2. Department of General Surgery, Eifelklinik St. Brigida, Simmerath, Germany

    Marc Niewiera

  3. Department of Orthopaedics and Traumatology, Alexandria University, Alexandria, Egypt

    Yasser El Mansy

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  1. Filippo Migliorini
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Correspondence to Filippo Migliorini.

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Migliorini, F., Eschweiler, J., Niewiera, M. et al. Better outcomes with patellar resurfacing during primary total knee arthroplasty: a meta-analysis study. Arch Orthop Trauma Surg 139, 1445–1454 (2019). https://doi.org/10.1007/s00402-019-03246-z

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