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PEARLS & PITFALLS – SURGICAL TECHNIQUE

Management of the Patella Resurfacing has been questioned due to frequent

on Total Knee Arthroplasty
complication rates, between 4% and 50%. The most
common reasons for patellar complications are patellar

fracture, instability, loosening, tendon breakage and soft
tissue impingement. These complications have led surgeons
to prefer non-resurfacing in order to avoid such disastrous

complications. However, these complications could be
attributed to implant types used with lower desigs and the
David Sadigursky, MD
Salvador, Bahia, BRAZIL
surgical technique employed (Boyd 1993). Consequently,
new implants were developed with more anatomic formats
to support the patella during the range of motion, known

as “patella-friendly” TKA (Matsuda 2000). However, the
studies were unable to demonstrate differences in results

when compared with the rest of these implants not deemed
One of the subjects of greatest controversy in total knee “patella-friendly”.

arthroplasty (TKA), refers to resurfacing (RS) or not the
patella (NRS). Arguments both for and against the procedure

have been individually justified and reported in the literature.

The resurfacing technique began to be performed due to a
greater incidence of anterior knee pain, with non-resurfacing,
undergoing modifications in the components used over

the years, increasing from 30% to 68% between 1970
and 1985 (Ranawat 2002). More recently, this popularity

started to decline, and patellar non-resurfacing started to
gain popularity among surgeons around the world. Some
authors recommend not resurfacing the patella (NRS),

some recommend selectively resurfacing the patella and
others recommend always resurfacing the patella (RS).

Data published in the literature show that, in the short term,
the outcome scores are similar when it comes to pain

and function, in addition to the fact that the two groups of
patients present postoperative complications, adding further
debate on the subject.

Historical studies between 1986 and 2003 about non-
Over 25 years, the proportion of reviews attributed to patella
resurfacing showed a higher incidence of anterior knee pain,
between 10% and 29%, in comparison to those who did resurfacing have been dropping from almost 50% in 1980
to about 12% presently. The prevalence of patellofemoral
the patellar component (Soudry & Insall 1986; Picetti 1990; complications have also declined significantly, rating around
Levitzky& Scott 1993; Boyd 1993; Water & Bentley 2003).
In meta-analysis studies between 2005 and 2009, results 4%–5% currently (Schindler 2011).

with greater anterior knee pain and higher re-operation rates Pavlou et al., in a meta-analysis performed with 18
are demonstrated. Rheumatoid arthritis patients, however, randomized controlled trials compared resurfacing during

present the best results, with resurfacing featuring as a TKA (n = 3463) with NRS patients (n = 3612), finding no
consensus in these studies.
significant difference between the groups regarding the
prevalence of anterior knee pain and functional outcome.

The authors demonstrated the weaknesses of the study,
which depended on the quality of the randomized trials

included, with different follow-ups and different implant
designs that were analysed together. Even if non-resurfacing

patients have the option of a new resurfacing procedure in
second time, the literature has been demonstrating lower
results in anterior knee pain relief in these reoperation cases.

Muoneke et al. in 2003, in a study with 20 patients who
underwent a resurfacing procedure in second time, with a

follow-up of 6 months, demonstrated that only 44% of the
patients improved, while 30% had complications such as

fracture, instability and decreased range of motion, which
denote a procedure with inferior results when performed in
second time.

18 ISAKOS NEWSLETTER 2014: Volume II