TY - JOUR
T1 - Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?
AU - Maradit-Kremers, Hilal
AU - Haque, Omar J.
AU - Kremers, Walter K.
AU - Berry, Daniel J.
AU - Lewallen, David G.
AU - Trousdale, Robert T.
AU - Sierra, Rafael J.
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Background To resurface or not to resurface the patella remains a controversy in total knee arthroplasty (TKA). The purpose of this study was to assess the long-term outcomes associated with selectively not resurfacing the patella. Methods This was a historical cohort study of 15,497 patients with 21,371 primary TKA procedures performed at a single institution between 1985 and 2010. The cohort included 402 (2%) knees with unresurfaced patellae and 20,969 knees with all-polyethylene patellae designs. Reasons for not resurfacing the patella were documented. Multivariable Cox regression analyses were used to estimate the risk of complications and revisions among procedures with unresurfaced patellae. Results According to the surgeon, reasons for not resurfacing were normal cartilage (226, 56%), young patient (30, 8%), thin patella (53, 13%), and surgeons' choice (93, 23%). In age, sex, and calendar year-adjusted analyses, the risk of complications (hazard ratio [HR]: 1.25, 95% confidence interval [CI]: 1.06, 1.46) and all-cause revisions (HR: 1.39, 95% CI: 1.02, 1.89) were significantly higher after TKA with unresurfaced patellae. However, after adjusting for femoral component types and operative diagnoses, these associations were no longer significant. The only group with significantly worse outcomes were those with a thin patellae with increased risk of complications (HR: 2.66, 95% CI: 1.70, 4.17) and revisions (HR: 5.94, 95% CI: 2.35, 15.02). Yet, the excess risk in the thin patellae group was mainly due to infections, and not related to unresurfaced patellae. Conclusion Selectively not resurfacing the patella seemed to provide similar results compared with routine resurfacing.
AB - Background To resurface or not to resurface the patella remains a controversy in total knee arthroplasty (TKA). The purpose of this study was to assess the long-term outcomes associated with selectively not resurfacing the patella. Methods This was a historical cohort study of 15,497 patients with 21,371 primary TKA procedures performed at a single institution between 1985 and 2010. The cohort included 402 (2%) knees with unresurfaced patellae and 20,969 knees with all-polyethylene patellae designs. Reasons for not resurfacing the patella were documented. Multivariable Cox regression analyses were used to estimate the risk of complications and revisions among procedures with unresurfaced patellae. Results According to the surgeon, reasons for not resurfacing were normal cartilage (226, 56%), young patient (30, 8%), thin patella (53, 13%), and surgeons' choice (93, 23%). In age, sex, and calendar year-adjusted analyses, the risk of complications (hazard ratio [HR]: 1.25, 95% confidence interval [CI]: 1.06, 1.46) and all-cause revisions (HR: 1.39, 95% CI: 1.02, 1.89) were significantly higher after TKA with unresurfaced patellae. However, after adjusting for femoral component types and operative diagnoses, these associations were no longer significant. The only group with significantly worse outcomes were those with a thin patellae with increased risk of complications (HR: 2.66, 95% CI: 1.70, 4.17) and revisions (HR: 5.94, 95% CI: 2.35, 15.02). Yet, the excess risk in the thin patellae group was mainly due to infections, and not related to unresurfaced patellae. Conclusion Selectively not resurfacing the patella seemed to provide similar results compared with routine resurfacing.
KW - arthroplasty
KW - knee
KW - knee revision
KW - patella
KW - resurfacing
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U2 - 10.1016/j.arth.2016.10.014
DO - 10.1016/j.arth.2016.10.014
M3 - Article
C2 - 27876254
AN - SCOPUS:85006853576
SN - 0883-5403
VL - 32
SP - 1143
EP - 1147
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 4
ER -