Does Patellar Resurfacing Improve Outcomes in Valgus Osteoarthritis with Compromised Patellofemoral Joint Status? A Retrospective Consecutive Comparative Study.

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Abstract

Conflict of interest statement: The authors declare no conflicts of interest. 17. J Exp Orthop. 2021 Nov 24;8(1):107. doi: 10.1186/s40634-021-00425-z. No patella resurfacing total knee arthroplasty leads to reduction in the thickness of patellar cartilage to less than half within 5 years: a quantitative longitudinal evaluation using MRI. Sato D(1), Inoue M(2), Sasaki T(3), Uchida J(4), Onodera T(5), Kondo E(6), Iwasaki N(5). Author information: (1)Department of Orthopaedic Surgery, NTT East Japan Sapporo Hospital, Minami-1, Nishi-15, Chuou-ku, Sapporo, Hokkaido, 060-0061, Japan. (2)Department of Orthopaedic Surgery, NTT East Japan Sapporo Hospital, Minami-1, Nishi-15, Chuou-ku, Sapporo, Hokkaido, 060-0061, Japan. inomasa@rose.ocn.ne.jp. (3)Department of Orthopaedic Surgery, Hokushin Higashi Orthopedic Hospital, Fushiko-5-3-3-2, Higashi-ku, Sapporo, Hokkaido, 007-0865, Japan. (4)Department of Orthopaedic Surgery, Hokkaido Orthopaedic Memorial Hospital, Hiragishi-7-13-5-22, Toyohira-ku, Sapporo, Hokkaido, 062-0937, Japan. (5)Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan. (6)Centre for Sports Medicine, Hokkaido University Hospital, Kita-14 Nishi-5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan. PURPOSE: Patellar resurfacing in total knee arthroplasty (TKA) remains controversial as recent meta-analyses have not shown its clear superiority; however, most authors recommend it because it is associated with less frequent anterior knee pain and need for reoperation. We aimed to clarify the changes in patellar cartilage thickness in no patellar resurfacing TKA using a ceramic femoral component on magnetic resonance imaging (MRI). METHODS: Between 2009 and 2014, 40 consecutive patients (59 knees) were included in this study. All patients underwent TKA using zirconia ceramic femoral implants without patellar resurfacing. Indications for no patellar resurfacing TKA were absence of anterior knee pain, patellar compression pain, and osteoarthritic changes in the patellofemoral joint on plain radiography. The mean postoperative follow-up duration was 81.5 months (range, 25-131 months). Clinical and radiological evaluations were performed preoperatively and 5 years after TKA. Patellar cartilage thickness was evaluated preoperatively and every year for 5 years after TKA using MRI T2-weighted imaging. The patellar cartilage was divided into three regions of interest: medial, central, and lateral. To standardise the variation in patellar thickness among patients, the percent cartilage thickness was calculated. RESULTS: The implant's position was appropriate in all cases. Compared to preoperative scores, 5 years postoperatively, the Japanese Orthopedic Association score and Oxford knee score significantly improved from 52.1 to 84.7; mean tilting angle and congruence angle did not change significantly; mean lateral shift ratio significantly increased from 7.1% to 14.6%; cartilage thickness significantly decreased (P