(1) East and North Hertfordshire NHS Trust, Lister Hospital Stevenage
(2) University of Leeds
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The issue of patella resurfacing following Total Knee Arthroplasty (TKA) has always been controversial among Orthopaedic surgeons. There are a lot of arguments, for or against patella resurfacing; and a lot of evidence has been published to support or discourage the procedure. Therefore, this review, aims to analyse the evidence in the literature, for or against patella resurfacing, with a view to finding out which has more support and better outcomes for patients.
This is a narrative review of the literature to find the relevant articles related to patella resurfacing after TKA. A search was carried out on Pubmed using the appropriate words to come up with any published evidence regarding this procedure. These articles were read by the authors and relevant arguments for or against the procedure were documented and critically analysed.
Many articles gave advantages and disadvantages for patella resurfacing following TKA. However, most of them are in favour of selective resurfacing or non-resurfacing of the patella, on a case by case basis. There is also need to discuss the issue fully with patients, and make them understand why such a decision is taken, in order to avoid misplaced expectations or disappointment if complications arise.
Discussion and Conclusion
TKA is a reliable procedure used to correct knee deformities, relieve pain and improve knee function usually following arthritis. Anterior knee pain is a major post-operative complication that compromises patient’s satisfaction. This led to several techniques of treatment to be proposed, which include patella denervation and resurfacing. However, patella resurfacing has become a controversial issue, which necessitates proper review of the literature, with a view to establishing the strongest evidence available in support of the procedure. However, from the review of current literature, there is no sufficient evidence to support the idea of routine resurfacing or non-resurfacing of the patella. Therefore, it may be more sensible to selectively resurface the patella based on an objective assessment of pre-operative symptoms, radiographic images and intra-articular findings of the arthritis affecting the patello-femoral joint. There is also need to involve the patient in the decision so that we can have an informed consent before carrying out the procedure.