Failure to resurface the patella during total knee arthroplasty may result in more knee pain and secondary surgery

Resurfacing the patella during primary total knee arthroplasty is controversial. The objective of this meta-analysis was to evaluate the outcome of total knee arthroplasty with or without resurfacing of the patella with particular attention to patient satisfaction, incidence of anterior knee pain, patellar complications, and the need for secondary operations. Computerized databases were searched for citations and published randomized clinical trials relevant to patellar resurfacing from 1966-2003. Of 158 citations identified as related to patellar resurfacing during total knee arthroplasty, 14 articles met all inclusion criteria for this study. The incidence of anterior knee pain was greater in knees with nonresurfaced patellas. Secondary resurfacings for anterior knee pain was needed in 8.7% of nonresurfaced knees. No difference in reported complications existed. Total knee arthroplasty resulted in improvement of functional outcome regardless of whether the patella was resurfaced. Based on the results of this meta-analysis, nonresurfacing of the patella during primary total knee arthroplasty is likely to result in a greater incidence of anterior knee pain, the need for secondary resurfacing in almost one in 10 patients, and possibly less patient satisfaction.