Total knee arthroplasty (TKA), or knee replacement surgery, is a standard procedure to relieve pain and improve function in patients with knee osteoarthritis. One aspect of TKA that has been debated among surgeons is whether or not to resurface the patella, the kneecap. The surgeon's preference has historically been the primary determinant of whether or not patellar resurfacing (PR) is performed, with some surgeons routinely resurfacing the patella, some selectively resurfacing, and others rarely resurfacing.
A prospective, randomized, controlled clinical trial compared the outcomes of TKAs with PR and without PR. The study randomly assigned 50 patients with primary knee osteoarthritis to either the PR or non-PR group. The patients were evaluated at multiple time points postoperatively, including 3, 6, and 12 months, using the Knee Society Score (KSS) and isokinetic measurements to assess their knee function and strength.
The trial results showed that the PR group had a higher mean score in the functional component of KSS, although the difference was not statistically significant. There were no significant differences between the groups in knee flexion peak torque, which measures the strength of the knee in bending the leg. However, knee extension peak torque, which measures the strength of the knee in straightening the leg, was significantly higher in the PR group at six months and one year postoperatively.
Based on these findings, the study concluded that PR during TKA is associated with better isokinetic performance and higher knee scores. This suggests that routine or usual resurfacing of the patella may be beneficial. For surgeons who are undecided or selectively resurface the patella, the advantage of better isokinetic performance may be a factor to consider in favor of resurfacing the patella.
Further research may be needed to understand the long-term effects of PR on knee function and patient satisfaction. In the meantime, it is crucial for surgeons to carefully weigh the potential benefits and risks of PR in each patient and make informed decisions based on the best available evidence and their clinical expertise.