Abstract
Total knee arthroplasty (TKA) is the best treatment for advanced knee osteoarthritis
and it has proven to be durable and effective. Anterior knee pain (AKP) is still one
of the most frequent complications after TKA, but sometimes no recognized macroscopic
causes can be found. The correct treatment of patella is considered the key for a
proper management of AKP. The inclusion of patellar resurfacing during TKA has been
described as a potential method for the reduction of AKP. After surgeons started to
resurface the patella, new complications emerged, such as component failure, instability,
fracture, tendon rupture, and soft tissue impingement. Patelloplasty has been proposed
as a good alternative to resurfacing but whether or not to resurface the patella is
still a controversial topic in the literature. Therefore, patellofemoral joint is
a complex critical aspect in TKA and choosing between the several options of treatment
of patella could not be sufficient. In this review, evidence-based studies do not
succeed in resolving this difficult argument. The accurate management of the so-called
“third space” should include an accurate assessment of cartilage layers, balance of
soft tissue, preoperative anterior tracking, and positioning of the femoral and tibial
components. In fact, the selection of suitable implants and adherence to proper surgical
technique are the fundamental principles for the success of TKA.
Keywords
total knee arthroplasty - patella - resurfacing - patelloplasty - patellofemoral joint
