Patellar resurfacing versus nonresurfacing in total knee arthroplasty for osteoarthritis: experience at a tertiary care institution in Pakistan

Akil Fazal¹, Riaz H Lakdawala^2
1Clinical Fellow, NYU Hospital for Joint Disease, New York, US; ²Associate Professor and Chief, Section of Orthopedics, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan

Objective: To determine the effect of patellar resurfacing in patients offered total knee arthroplasty for osteoarthritis.
Design: Randomized control study.
Place and duration of study: The Aga Khan University Hospital, Karachi, Pakistan from January 3, 2005 to January 9, 2010.
Patients and methods: Patients undergoing primary total knee arthroplasty for osteoarthritis were assigned to either the patellar resurfacing or nonresurfacing arm using systematic sampling. This consisted of patients undergoing unilateral and bilateral knee arthroplasty. Preoperatively, Knee Society Knee and Function Scores were calculated. After a minimum of 3 years postoperatively Knee Society Knee and Function Scores as well as the Clinical Anterior Knee Pain Rating were calculated and analysis done to check for differences.
Results: Seventy-five patients were recruited in each arm; 135 patients had bilateral and 15 had unilateral knee arthroplasty. The mean preoperative knee score was 40.4 for the resurfacing group and 40.60 for the nonresurfacing group (P = 0.45). This improved postoperatively to 93.67 and 94.23 respectively, with no difference between the two groups (P = 0.67). The mean preoperative function score was 45.50 for resurfaced patellae and 45.83 for nonresurfaced. This improved to 89.67 and 90.50, respectively, again with no difference (P = 0.51). Postoperative Clinical Anterior Knee Pain Rating was a mean of 0.1 for resurfaced and 0.13 for nonresurfaced patellas, with no difference on analysis (P = 0.06). However, patients who had bilateral knee arthroplasty had a slightly higher Clinical Anterior Knee Pain Rating than those who had single knee surgery (P = 0.046) irrespective of whether the patellar was resurfaced or not.
Conclusion: In patients undergoing primary Total Knee Arthroplasty for osteoarthritis, there is no added advantage of performing resurfacing of the patellar at 3 years of follow-up.

Keywords: patellar, patellar ligament, patellofemoral pain syndrome, arthroplasty subchondral, arthroplasy replacement knee, osteoarthritis knee, Pakistan