Patellar Resurfacing TKA Always! Michael Kelly, M.D Chairman Orthopaedic Surgery Hackensack University Medical Center
Disclosures • Zimmer-consultant,royalties • Pacira-consultant • Acuitive Technologies-consultant • Healthtrust-consultant • Mallinkrodt-speakers bureau • Vox Telehealth-advisory board
Patellar Replacement?
Historically - 1970’s Total Condylar Prosthesis • Patello-femoral articulation • Patellar component
Literature Not Conclusive (early 1990s) Keblish PA, et al. JBJS 1994 Bourne RB, et al. CORR, 1995 Feller JA, et al. JBJS, 1996 Barrack RL, et al. JBJS 1997
Resurfaced vs. Natural Patella No significant difference: 10% Anterior Knee Pain Keblish PA, et al. JBJS 1994 Barrack RL, et al. JBJS 1997
Patellar Complications Patellar fracture Patellar instability Extensor mechanism disruption Patellar component wear Patellar component loosening Patellar component disassociation
Patellar Clunk
Patellar Clunk
Patellar Complications Older literature not relevant • 50% revisions related to patella complications Improved component designs Improved surgical techniques Dennis: Am. J Knee Surg.: 5, 1992
Burnett et al: • BTKA-prospective randomized 64 TKAs • Living pts. f/ u minimum 10 yrs • Anterior knee pain 17% with/ without resurfacing CORR: 464-2007
Wood DJ et al: • Prospective randomized study-220 TKAs • f/ u mean 48 months (36-79 mons) • 12% non resurfaced 10% resurfaced had revision surgery related to PF joint • Resurfaced group had less anterior knee pain and better stair descent JBJS 84-A #2:2002
Patellar Resurfacing TKA ? Meta-Analyses • Pilling RWD et al:JBJS 94-A #24:2012 • Parvizi J et al:CORR 438:2005 • He Ji-Ye et al:The Knee 18 :2011 • Pakos EE et al:JBJS 87A#7:2005 • Abdel M et al:Curr Rev Musculoskel. Med (7) 2014
Patellar Resurfacing TKA ? Meta-Analyses • Nonresurfacing Patella Primary TKA: • Increased incidence anterior knee pain • Increased incidence reoperation for PF issues • Poss ? Less pt satisfaction
Resurfacing Unresurfaced Patella Primary TKA • Parvizi J et al: • 39 pts (41 tka)-secondary patellar resurfacing TKA • 20% dissatisfied with their result • Knee scores improved whole cohort Garcia R et al:Jnk • 17 pts (17 tka)-secondary patellar resurfacing • 47% anterior knee pain & dissatisfied with results • Knee scores improved whole cohort Parvizi Jnl Arthro vol 27 2012 Garcia Jnl Arthro vol 25 2010
Patellar Resurfacing Complications Minimal When Done Right 1% Revision Rate Barrack RL, et al. JBJS 2001
Results are Technique Dependent
Patellar Thickness
Fixation Holes
Bevel Cut Rosen, Scuderi: Tech. in Knee Surg, #1, 2002
Bevel Cut Rosen, Scuderi: Tech. in Knee Surg, #1, 2002
Tendon Debridement
Patellar Tracking
Prosthesis Design Anatomic femoral components Improved trochlear recess
Prosthesis Design Use “Friendly” Trochlea Patella must track properly
Patella Design
Patellar Resurfacing Surgeon Experience
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