Resurfacing versus not-resurfacing the patella in one-stage bilateral total knee arthroplasty: a prospective randomized clinical trial

Chengzhi Ha, Baoxin Wang, Wei Li, Kang Sun, Dawei Wang, Qicai Li, Chengzhi Ha, Baoxin Wang, Wei Li, Kang Sun, Dawei Wang, Qicai Li

Abstract

Purpose: Resurfacing the patella in one-stage bilateral total knee arthroplasty (TKA) remains debatable. This study aimed to assess the mid-term outcomes of patients after one-stage bilateral TKA performed with and without patellar resurfacing, respectively, with at least five years of follow-up.

Methods: Sixty-six patients (132 knees) scheduled for first-ever one-stage bilateral TKA due to osteoarthritis received patellar resurfacing and retention, respectively, on one knee and the other, randomly selected. All patients received Scorpio NRG knee prostheses and were evaluated by radiology (anteroposterior, lateral, and axial views) pre-operatively and yearly post-operatively, for at least five years. Knee Society Score and Feller Score values were measured. Anterior knee pain, patellar clunk, and patient satisfaction were assessed.

Results: One patient died within five years of operation and four were lost to follow-up. One patient developed severe dementia and could not be constructively questioned. Therefore, 60 patients (120 knees) were finally analyzed. There were significantly improved Knee Society and Feller scores (P < 0.001) in the resurfacing group compared with the non-resurfacing group post-operatively. Anterior knee pain and patellar clunk rates were lower on the resurfaced side compared with the non-resurfaced side (P < 0.001). Meanwhile, 47% and only 7% patients preferred the resurfaced and non-resurfaced sides, respectively, at final follow-up. No revision was performed for patellofemoral complications, and no significant differences were found between the two groups in radiographic outcomes.

Conclusions: Using the Scorpio NRG knee prosthesis, patellar resurfacing is superior to non-resurfacing in patients with osteoarthritis observed for ≥ five years.

Registration trials number: NCT03600922 KEY POINTS: • Findings Patellar resurfacing is superior to non-resurfacing in osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA) with the Scorpio NRG knee prosthesis. • Implications Patellar resurfacing should be performed in OA patients during TKA. • Caution Several prosthesis types should be assessed in the same study setting, and multicenter studies are required before generalizability of the present findings.

Keywords: Anterior knee pain; Osteoarthritis; Patellar resurfacing; Total knee arthroplasty.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
A 68-year-old woman with a preoperative diagnosis of bilateral osteoarthritis of the knee joint. a Left: resurfaced patella (black arrow). b Right: non-resurfaced patella (white arrow)
Fig. 3
Fig. 3
Pre-operative (1 week) and post-operative (3 days) X-ray examinations of a 68-year-old woman with bilateral osteoarthritis. Left: non-resurfaced patella. Right: resurfaced patella. a Anteroposterior position 1 week before operation. b Anteroposterior position 3 days after operation. c Lateral position of left knee joint 1 week before operation d Lateral position of left knee joint 3 days after operation (non-resurfaced). e Lateral position of right knee joint 1 week before operation. f Lateral position of right knee joint 3 days after operation (resurfaced)
Fig. 4
Fig. 4
Pre-operative (3 days) and post-operative (1 month) X-ray examinations (axial patella view) of a 68-year-old woman with bilateral osteoarthritis. Left: non-resurfaced patella. Right: resurfaced patella. One-month after the operation, the patient’s pain was significantly relieved, the activities were recovered well, and the post-operative joint flexion activity reached 110°. a Axial position 3 days before operation. b Left knee joint in the axial position 1 month after operation. c Right knee joint in axial position 1 month after operation

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