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Patellar Resurfacing in Total Knee Arthroplasty

Dr. Barrack is Professor of Orthopaedic Surgery and Director, Adult Reconstructive Surgery, Tulane University School of Medicine, New Orleans. Dr. Wolfe is Assistant Professor of Orthopaedic Surgery and Director, Musculoskeletal Tumor Surgery, Tulane University School of Medicine.

Reprint requests: Dr. Barrack, Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue SL32, New Orleans, LA 70112.

Whether or not to resurface the patella when performing a primary total knee arthroplasty remains an open question. A number of recent studies have added new information relevant to this controversy. Anatomic studies show that there is normally substantial variability in the anatomy of the trochlear groove. Implanting a femoral component therefore results in a change in the surface topography of the knee in a high percentage of cases. Even though a number of intraoperative techniques have been described in an attempt to accurately reproduce femoral and tibial component rotation, studies of the application of these techniques reveal that component malpositioning or malrotation of a measurable degree occurs in 10% to 30% of cases, depending on the surgical technique and landmarks used. There has been substantial change in the design of both femoral and patellar components in recent years. Even with current designs, biomechanical studies indicate that some degree of change in kinematics and contact stresses occurs following total knee arthroplasty. However, the results of clinical studies have been extremely variable, with most showing either no difference or very little difference between resurfaced and nonresurfaced patellae in osteoarthritic knees. The decision to resurface the patella or not must be individualized on the basis of the surgeon’s training and experience and an intraoperative assessment of the patellofemoral articulation.