Patellar Resurfacing in Total Knee Arthroplasty: Systematic Review and Meta-Analysis

Background: Patellar resurfacing in total knee arthroplasty remains controversial. The aim of this study is to evaluate this technique through an analysis of comparative studies in the current literature. Methods: We performed a comprehensive search of PubMed, MEDLINE, Cochrane, CINAHL, and EMBASE databases using various combinations of the keywords Knee, Replacement, Prosthesis, Patella, Resurfacing, and Arthroplasty. All articles relevant to the subject were retrieved, and their bibliographies were hand searched for further references relevant to primary patellar resurfacing in total knee arthroplasty. Only articles published in peer-reviewed journals were included in this systematic review. Results: The percentage for a reoperation was 1% for the patellar resurfacing group (17/1636) and 6.9% for the non-resurfacing group (118/1699) (odds ratio [OR] 0.18, 95% confidence interval [CI] 0.11-0.29, P < .00001). The patellar resurfacing group showed a significantly higher postop Knee Society Score (KSS) pain (OR 1.52, 95% CI 0.68-2.35, P = .004) and postop Hospital for Special Surgery score (OR 4.35, 95% CI 3.21-5.49, P < .00001), over the non-resurfacing group. Conclusion: Based on the outcome scores of KSS (pain), KSS (function), and Hospital for Special Surgery postop, patellar resurfacing TKAs have performed better than non-resurfaced TKAs. The lower secondary operation and revision rates for patellar resurfaced TKAs also demonstrate that this technique is the more effective option. However, the full impact of patellar resurfacing still needs to be critically evaluated by larger randomized controlled trials with long-term follow-up. (c) 2017 Elsevier Inc. All rights reserved.