Should surgeons resurface the patella during total knee arthroplasty (TKA)?
Many surgeons say no, citing inadequate patellar thickness.
Yet a study from Mayo Clinic suggests that the answer may be yes, even in patients with a thin patella.
The study, designed to describe implant survivorship, reoperations, complications, and clinical outcomes in patients who underwent resurfacing of a thin native patella, received the AAHKS Surgical Techniques and Technologies Award from the American Association of Hip and Knee Surgeons during their 2022 annual meeting. This award recognizes outstanding advancement in surgical innovation within reconstructive surgery.
“Patients with a thin patella often have significant patellofemoral arthritis, and prior data from our institution found higher revision rates in similar patients who were left unresurfaced. For this reason, we sought to determine whether resurfacing was safe in this patient population,” said Jacob M. Wilson, MD, lead author of the study.
“Our results suggest that this is a safe practice, and we hope these data will be useful to surgeons when encountering this clinical situation.”
Study Cohort and Findings
For this study, Dr. Wilson and his colleagues identified 11,333 patients who underwent primary TKA with patellar resurfacing between 2000 and 2010. They observed high rates of survivorship free of:
- Patella revision: 98% survivorship
- Patella-related reoperation: 98% survivorship
- Periprosthetic patella fracture: 99% survivorship
- Patella-related complication: 97% survivorship
Three patients underwent patella revision, 1 for patellar component aseptic loosening and 2 for prosthetic joint infection (PJI). Two additional patella-related reoperations were performed, both arthroscopic synovectomies for patellar clunk, and 2 patients underwent manipulation under anesthesia. Three periprosthetic patella fractures were managed non-operatively; all 3 patients had well-fixed components and an intact extensor mechanism.
Radiographically, the patella appeared well fixed in all non-revised knees. Knee Society Scores improved from a mean of 36 preoperatively to a mean of 81 at 10 years postoperatively.
The researchers concluded that resurfacing the thin native patella was associated with high survivorship free of patellar revision at 10 years after surgery.
Wilson JM, Sullivan MH, Pagnano MW, Trousdale RT. Resurfacing the thin native patella: is it safe? Presented at the annual meeting of the American Association of Hip and Knee Surgeons, November 3-6, 2022, Dallas, Texas.