Dr. Haas: No resurfacing of the patella is a great idea, if you like to re-operate on your patients. If I re-operate on a patient, they’re mad at me because they said, “Why didn’t you get rid of the arthritis you said was there? It was bone-on-bone. You said that was bad. Why didn’t you get rid of it?” So, they have lawyers climbing up my butt. Or at least if they don’t have a lawyer, they’re mad at me. And I don’t like to have patients mad at me.
So, what are the data? First of all, the cartilage may not be normal in the first place. Cushner showed that there are abnormal pathologic changes in the cartilage. Patella resurfacing, in data, shows that the rate of complications is actually pretty low. And you may recognize some of those authors (Boyd, et al., JBJS, 1993; Barrack, et al., JBJS, 2001; Erak, et al., Clin Orthop, 2009).
Not resurfacing the patella is associated with a higher revision rate. That’s just clear. Patients just don’t like being revised, and the pain is about equal or more. So, I’ll give you that it’s equal. However, if it’s equal, then it may have to get operated on more. Knees don’t get better when you re-operate on them.
Almost all meta-analyses show a similar thing. The non-resurfaced get re-operated on more and they have anterior knee pain in both groups. (Nizard, et al., Clin Orthop, 2005).
In most of the data…14 studies, non-resurfaced patellae have a greater incidence of anterior knee pain. Non-resurfaced patellae resulted in less patient satisfaction (Parvizi, et al., Clin Orthop, 2005).
Ten studies, 1,223 knees, again, patellar resurfacing reduces risk of reoperation and anterior knee pain. (Pakos, et al., JBJS Am, 2005).
Reoperation rate significantly higher in non-resurfaced group. Resurfacing 1.9% compared to 4% non-resurfacing. (Fiddian & Murray, KAT Group, Interim KS 2009)
In fact, a study by Dr. Barrack—patellar resurfacing versus non-resurfacing. No significant difference in knee pain, range of motion, patella function. And they didn’t even have a preference in bilateral knees (Barrack, et al., JBJS, 2001).
If you look at this large study of 6,000 patients, the incidence of patellofemoral pain is higher in the non-resurfaced group than the resurfaced group (Tubutin, et al., KSSTA, 2005).
Same again, anterior patella resurfacing, less anterior knee pain, less patella-related reoperation. And, in fact, lower satisfaction scores when the patella is not resurfaced (Calvisi, et al., AOTS, 2009).
We go through the Australian Orthopaedic Association National Joint Replacement Registry (Clements, et al., Acta Orthop, 2010) you’re going to see the same thing. I think this is one of the more well studied entities in orthopedic surgery.
In conclusion, it’s really pretty simple. People hate being re-operated. Since our primary goal is relieve pain and there’s a higher incidence of anterior knee pain and more reoperations, I favor to resurface the patella, except in selected cases.
