Abstract
Introduction: The majority of patients with osteoarthritis of the knee suffer from femorotibial pain with a smaller proportion suffering predominantly patello-femoral symptoms. No clear consensus exists as to the need for patellar resurfacing when performing total knee replacement for patients with symptomatic femorotibial osteoarthritis but without prominent patello-femoral symptomatic and radiographic disease.
Aims: To identify the advantages and disadvantages of both resurfacing and non-resurfacing of the patella during cemented total knee replacement performed for osteoarthritis predominantly of the femorotibial joint. To objectively clarify the rationale for the use of either procedure in clinical practice.
Methods: Prospective randomized double blinded clinical trail. Patients with osteoarthritis of the knee and principally femorotibial symptoms were included. Patients with rheumatoid arthritis, gross deformity of the knee and gross radiological or clinical patello-femoral arthritis were excluded. The implant used was a cemented posterior stabilized AMK (Depuy, Leeds UK) prosthesis. Pre-operative American Knee Society Score, SF-36 questionnaire and WOMAC scores were calculated for each patient. These instruments were repeated and combined with clinical and radiological follow up at 3 months, 6 months and one year.
Results: 58 patients were recruited into the study, 53 of whom completed follow-up and were included in the analysis. Baseline characteristics were similar in each group. Operating room time was less in the non-resurfaced group (p< 0.05). At one year, no patient in either group had needed to undergo a revision procedure. There was no difference between the resurfaced and non-resurfaced groups in terms of global functional outcome as measured by SF36 and WOMAC scores at one-year post operatively. The American Knee Society score showed no difference between the two groups (p=0.86) at one-year post surgery.
Conclusion: There is no significant difference in clinical outcome at one year following surgery vis-à-vis those who did and did not have patellar resurfacing performed during knee replacement for predominantly femorotibial symptomatic osteoarthritis. Patellar resurfacing as a procedure is not without complications. In patients with osteoarthritis of the knee and predominantly femorotibial disease based on clinical and radiographic findings, we do not advocate the routine use of patellar resurfacing.
The abstracts were prepared by Raymond Moran. Correspondence should be addressed to him at the Irish Orthopaedic Assocation, c/o Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
