Surgical Technique for Symmetric Patellar Resurfacing during Total Knee Arthroplasty

Abstract

Patellar resurfacing is a commonly performed procedure during total knee arthroplasty (TKA). Common goals of patellar resurfacing are to obtain a stable, functional, patellofemoral joint with minimal pain. This is typically accomplished by resecting the patella in a symmetric fashion while attempting to restore native patellar thickness. Several cutting guides have been developed to assist with patellar resurfacing during TKA; however, we feel that the patella can be resected in a predictably symmetric fashion without the use of cutting guides or other specialized equipment. The following is a description of a novel patellar resurfacing technique that reproducibly results in a smoothly resected patella that is free of asymmetry and obliquity without the use of cutting guides. It can reliably be performed in an efficient manner that reduces equipment needs without prolonging operative time.

Keywords

patella - resection - technique - total knee arthroplasty - symmetric

• References

• 1 Barrack RL, Bertot AJ, Wolfe MW, Waldman DA, Milicic M, Myers L. Patellar resurfacing in total knee arthroplasty. A prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Am 2001; 83-A (9) 1376-1381
• 2 Burnett RS, Boone JL, McCarthy KP, Rosenzweig S, Barrack RL. A prospective randomized clinical trial of patellar resurfacing and nonresurfacing in bilateral TKA. Clin Orthop Relat Res 2007; 464: 65-72
• 3 Burnett RS, Haydon CM, Rorabeck CH, Bourne RB. Patella resurfacing versus nonresurfacing in total knee arthroplasty: results of a randomized controlled clinical trial at a minimum of 10 years' followup. Clin Orthop Relat Res 2004; (428) 12-25
• 4 Campbell DG, Duncan WW, Ashworth M , et al. Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. J Bone Joint Surg Br 2006; 88 (6) 734-739
• 5 Schroeder-Boersch H, Scheller G, Fischer J, Jani L. Advantages of patellar resurfacing in total knee arthroplasty. Two-year results of a prospective randomized study. Arch Orthop Trauma Surg 1998; 117 (1–2) 73-78
• 6 Smith AJ, Wood DJ, Li MG. Total knee replacement with and without patellar resurfacing: a prospective, randomised trial using the profix total knee system. J Bone Joint Surg Br 2008; 90 (1) 43-49
• 7 Wood DJ, Smith AJ, Collopy D, White B, Brankov B, Bulsara MK. Patellar resurfacing in total knee arthroplasty: a prospective, randomized trial. J Bone Joint Surg Am 2002; 84-A (2) 187-193
• 8 Pakos EE, Ntzani EE, Trikalinos TA. Patellar resurfacing in total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 2005; 87 (7) 1438-1445
• 9 Parvizi J, Rapuri VR, Saleh KJ, Kuskowski MA, Sharkey PF, Mont MA. Failure to resurface the patella during total knee arthroplasty may result in more knee pain and secondary surgery. Clin Orthop Relat Res 2005; 438: 191-196
• 10 Rand JA. Patellar resurfacing in total knee arthroplasty. Clin Orthop Relat Res 1990; (260) 110-117
• 11 Barrack RL, Wolfe MW. Patellar resurfacing in total knee arthroplasty. J Am Acad Orthop Surg 2000; 8 (2) 75-82
• 12 Bindelglass DF, Cohen JL, Dorr LD. Patellar tilt and subluxation in total knee arthroplasty. Relationship to pain, fixation, and design. Clin Orthop Relat Res 1993; (286) 103-109
• 13 Pagnano MW, Trousdale RT. Asymmetric patella resurfacing in total knee arthroplasty. Am J Knee Surg 2000; 13 (4) 228-233
• 14 Ranawat CS. The patellofemoral joint in total condylar knee arthroplasty. Pros and cons based on five- to ten-year follow-up observations. Clin Orthop Relat Res 1986; (205) 93-99
• 15 Sneppen O, Gudmundsson GH, Bünger C. Patellofemoral function in total condylar knee arthroplasty. Int Orthop 1985; 9 (1) 65-68
• 16 Fu CK, Wai J, Lee E , et al. Computer-assisted patellar resection system: development and insights. J Orthop Res 2012; 30 (4) 535-540
• 17 Hurson C, Kashir A, Flavin R, Kelly I. Routine patellar resurfacing using an inset patellar technique. Int Orthop 2010; 34 (7) 955-958
• 18 Lombardi Jr AV, Mallory TH, Maitino PD, Herrington SM, Kefauver CA. Freehand resection of the patella in total knee arthroplasty referencing the attachments of the quadriceps tendon and patellar tendon. J Arthroplasty 1998; 13 (7) 788-792
• 19 Ledger M, Shakespeare D, Scaddan M. Accuracy of patellar resection in total knee replacement. A study using the medial pivot knee. Knee 2005; 12 (1) 13-19
• 20 Boyd Jr AD, Ewald FC, Thomas WH, Poss R, Sledge CB. Long-term complications after total knee arthroplasty with or without resurfacing of the patella. J Bone Joint Surg Am 1993; 75 (5) 674-681
• 21 Clements WJ, Miller L, Whitehouse SL, Graves SE, Ryan P, Crawford RW. Early outcomes of patella resurfacing in total knee arthroplasty. Acta Orthop 2010; 81 (1) 108-113
• 22 Enis JE, Gardner R, Robledo MA, Latta L, Smith R. Comparison of patellar resurfacing versus nonresurfacing in bilateral total knee arthroplasty. Clin Orthop Relat Res 1990; (260) 38-42
• 23 Fu Y, Wang G, Fu Q.. Patellar resurfacing in total knee arthroplasty for osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2011; 19 (9) 1460-1466
• 24 Helmy N, Anglin C, Greidanus NV, Masri BA. To resurface or not to resurface the patella in total knee arthroplasty. Clin Orthop Relat Res 2008; 466 (11) 2775-2783
• 25 Hsu HP, Walker PS. Wear and deformation of patellar components in total knee arthroplasty. Clin Orthop Relat Res 1989; (246) 260-265
• 26 Picetti III GD, McGann WA, Welch RB. The patellofemoral joint after total knee arthroplasty without patellar resurfacing. J Bone Joint Surg Am 1990; 72 (9) 1379-1382