Abstract
The decision to resurface the patella has been well studied. While regional differences exist, the overwhelming choice by most surgeons in the United States is to resurface the patella. Data supports that this is the correct choice.
Articular cartilage on metal has not been shown to be a good long term bearing surface. Cushner et al has also shown that cartilage in the arthritic knee has significant pathologic abnormalities.
Patella surfacing has excellent long-term results with a low complication rate. Anterior knee pain is a common complaint after knee replacement and is even more common in TKA with unresurfaced patella. Pakos et al had more reoperations and greater anterior knee pain when the patella was NOT resurfaced. Parvizi et al also found less patient satisfaction with unresurfaced patellas.
Meta-analysis results indicate higher revision rates with unresurfaced patellas. Bilateral knee studies also favor resurfaced patella. Higher revision rates were also confirmed in the Swedish Registry with a 140% higher revision rate in TKA with unresurfaced patellas.
In addition second operations to resurface the patella often are unsuccessful at alleviating pain.
Surgeons who choose not to resurface the patella must accept that their patients will have the same or greater degree of anterior knee pain and a significantly greater risk for reoperation.
