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The long term results of patients treated with total knee athroplasty (TKA) have revealed that 90% of cases had a 15 year survival rate. However, a considerable proportion of these cases reported poor functional outcomes and persistent anterior knee pain due to patello-femoral joint related problems despite an otherwise well performed knee replacement
The role of patellar resurfacing in total knee arthroplasty (TKA) is still debatable. No clear consensus was reported by different studies regarding the mechanical and clinical significance of patellar resurfacing. Many surgeons choose to apply patellar resurfacing on a routine basis, others do not resurface the patella at all, a third group supports resurfacing the patella selectively.
Some authors prefer resurfacing arguing that the incidence of anterior knee pain is reduced and fewer revision surgeries are required. However, others opposing patellar resurfacing reported postoperative patellar loosening, osteonecrosis, patella clunk syndrome, patellar fracture, and diminished difference in the incidence of anterior knee pain.
It was suggested that patellar resurfacing should be limited to patients with severe preoperative patellar pain, inflammatory arthritis, thick or large patella, in addition to patients with history of patellar maltracking. On the other hand, insufficient patellar bone stock is known to be a major contraindication to patellar resurfacing.
When resurfacing the patella, the surgeon is required to adhere to strict surgical principles in order to mantain patellar thickness, preserve patellar blood supply, achieve appropriate positioning of all implant components, and balanced soft tissues to allow for central patellar tracking It appears that patellar resurfacing can be performed at any given stage of the operation and according to surgeon preference.
from 2000 to 2017, after detailed evaluation, 14 independent randomised controlled trials with a cumulative sample size of 1,770 knees at final follow-up of minimum 5 years were included in the overall meta-analysis. The methodological quality is shown to see the risk of bias. Studies provided data on reoperations during follow-up, prevalence of postoperative anterior knee pain of any grade, Knee society function score, knee society pain score and knee Society Score.
This meta-analysis shows that patellar resurfacing may reduce the risks of reoperation after total knee arthroplasty. Interestingly the patellar resurfacing group might achieve a higher Knee Society score and Knee society function score than the non-resurfacing group. There was no difference between the two groups in terms of anterior knee pain. The most important finding of this systematic review and meta-analysis is that the non- resurfacing group had significantly better Knee society pain score compared to the resurfacing group. More high quality and well-designed randomised controlled trials with long-term follow-up are needed to support this conclusion.