Patellofemoral Joint Management in Total Knee Arthroplasty

The management of the patellofemoral joint in total knee arthroplasty (TKA) has a long and controversial history. Patellofemoral resurfacing has the potential to provide the patient with pain relief, especially in advanced patellofemoral disease, but it comes at the risk of complications including patella fracture, dislocation, and button dissociation. Avoidance of resurfacing allows the surgeon to circumvent these complications and simplify the surgery but there is the potential for anterior knee pain, advancing patellar arthritis, and need for secondary procedure for resurfacing.

The traditional dogma in the United States has been to resurface the patella in primary TKA. There has been a slow and steady trend toward decreased patellofemoral resurfacing in the United States based on the 2024 American Joint Replacement Registry data. In 2012, 95.9% of primary TKA were resurfaced, with this decreasing to 87.0% in 2024. There is high variability in resurfacing outside of the United States and is related to many factors including surgeon training, patient cultural factors, tradition, and clinical evidence. Patellar resurfacing in the setting of revision TKA is also a controversial topic and is dependent on many factors as to the need for revision surgery. Repeated revision of the patellofemoral joint is avoided when possible as failure of the extensor mechanism in the setting of arthroplasty is a highly morbid problem that has the potential to require invasive reconstruction procedures with mixed overall outcome.

This special issue of the Journal of Knee Surgery seeks to provide more answers to guide the surgeon on how to manage the patella in a variety of situations.

• Patellar Overstuffing in Total Knee Arthroplasty Results in Decreased Extensor Mechanism Efficiency

• Effect of Resurfaced Patellar Thickness on Outcomes after Total Knee Arthroplasty

• Contemporary Cementless Patellar Implant Survivorship: A Systematic Review and Meta-Analysis of 3,005 Patellae

• Early Improvement in Postoperative Clinical Outcomes without Patellar Resurfacing in Patella-friendly Design of Medial Pivot TKA

• Dalí Sign: Characterization and Case Series of Patellar Bony Shell Morphological Changes after Two-Stage Revision for Periprosthetic Joint Infection

I am very thankful to all of the authors for pouring their time and expertise into these articles to further advance our understanding and management of the patellofemoral joint in TKA. There is much work that still needs to be done on this topic but we hope this edition provides further guidance in regards to our decision-making for management of the patellofemoral joint.

Publication History

Article published online:
21 April 2025