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General Orthopaedics


Current Concepts in Joint Replacement (CCJR) – Spring 2015


To resurface or not to resurface the patella… that is the question. It all comes down to where you practice. It is controversial in that there is a risk of possible complications from resurfacing versus the potential for simply having complaints of pain which may supposedly arise from the anterior knee stemming from the unresurfaced patella.

The evolution of more favorable anatomic femoral component designs which are very friendly to the patellofemoral articulation have resulted in lower patella resurfacing complications. The insertion of appropriately externally rotated tibial and femoral components, if not reducing anterior knee pain, have certainly minimised the risk of resurfaced patella complications. Also, with current surgical techniques of component insertion, the lateral release rate is extremely low, thus avoiding the possibility of avascularity developing in the resurfaced patella. This complication will almost completely be eliminated if the patella thickness is kept greater than 13 mm after patella resection.

In my experience, patella complications from the resurfaced patella are extremely rare. Many unicompartmental knees require re-operation because of the development of progressive patellofemoral arthritis. Re-operation from anterior knee pain from progressive arthritis from the unresurfaced patella has given inferior results. Overall, meta-analysis data demonstrates decreased satisfaction, increased anterior knee pain and higher early revision rates in the unresurfaced group. National joint registries, especially the Australian registry support routine resurfacing; complications are low and outcomes are improved.

Even though there exists controversy as to whether the patella should be resurfaced or not, there is an overwhelming consensus in the U.S. that there is little downfall nowadays with respect to resurfacing the patella.