Patella resurfacing during total knee arthroplasty is cost-effective and has lower re-operation rates compared to non-resurfacing

Journal of Orthopaedic Surgery and Research

Nicola Maffulli¹  Talal Al-Jabri²  Nick D. Clement³  Thomas Parsons⁴  Deiary F. Kader⁵ 

[1] Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy;Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, E1 4DG, London, England;School of Pharmacy and Bioengineering, Keele University School of Medicine, ST5 5BG, Stoke on Trent, UK;Department of Surgery and Cancer, Imperial College London, SW7 2AZ, London, England;South West London Elective Orthopaedic Centre, Denbies Wing, Epsom General Hospital, KT18 7EG, Surrey, UK;Department of Orthopaedics, Royal Infirmary of Edinburgh, Little France, EH16 4SA, Edinburgh, UK;South West London Elective Orthopaedic Centre, Denbies Wing, Epsom General Hospital, KT18 7EG, Surrey, UK;Royal United Hospital Bath, Combe Park, BA1 3NG, Bath, Avon, UK;South West London Elective Orthopaedic Centre, Denbies Wing, Epsom General Hospital, KT18 7EG, Surrey, UK;University of Kurdistan Hewler, Erbil, Iraq;

关键词: Arthroplasty;    Patella;    Knee replacement;    Resurfacing;   

DOI  :  10.1186/s13018-021-02295-8

来源: Springer

【 摘 要 】

BackgroundThe decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon’s preference, education, training, tradition and geographic location. Advocates for non-resurfacing or selectively resurfacing may claim no difference in patient reported outcomes, and that resurfacing is associated with increased risks such as extensor mechanism injury or malalignment, problems with the design of the patella component and technical issues intraoperatively.AimsTo critically examine factors that should be considered in addition to patient reported outcomes in the decision process of resurfacing or non-resurfacing of the patella in total knee arthroplasty.MethodA comprehensive literature search was conducted to identify factors that may influence decision making in addition to knee specific patient reported outcome measures such as surgical risks, patient quality of life, procedure cost, re-operation rate, implant design, surgeons learning curve and the fate of remaining cartilage in native patellae.ResultsPatient-reported outcomes are equivocal for resurfacing and non-resurfacing. Critical analysis of the available literature suggests that the complications of resurfacing the patella are historic, which is now lower with improved implant design and surgical technique. Routine resurfacing was cost-effective in the long term (potential saving £104 per case) and has lower rates of revision (absolute risk reduction 4%). Finally, surgical judgment in selective resurfacing was prone to errors.ConclusionPatella resurfacing and non-resurfacing had similar patient-reported outcomes. However, patella resurfacing was cost-effective and was associated with a lower rate of re-operation compared to non-resurfacing.

【 授权许可】

CC BY