PMID- 36827957
OWN - NLM
STAT- MEDLINE
DCOM- 20230425
LR  - 20230425
IS  - 1873-5800 (Electronic)
IS  - 0968-0160 (Linking)
VI  - 41
DP  - 2023 Mar
TI  - Patellar resurfacing was not associated with a clinically significant advantage 
      when a modern patellar friendly total knee arthroplasty is employed: A systematic 
      review and meta-analysis.
PG  - 329-341
LID - S0968-0160(23)00031-5 [pii]
LID - 10.1016/j.knee.2023.01.021 [doi]
AB  - BACKGROUND: Modern total knee arthroplasty (TKA) femoral components are designed 
      to provide a more optimal articular surface for the patella whether or not it has 
      been resurfaced. Previous systematic reviews comparing outcomes of patellar 
      resurfacing and no resurfacing combine both historic and modern designs. AIMS: 
      The aim of this study was to investigate the effect of patellar resurfacing in 
      modern "patellar friendly" implants on (1) incidence of anterior knee pain, (2) 
      patient reported outcomes (3) complication rates, and (4) reoperation rates 
      compared with unresurfaced patellae in primary TKA. METHODS: MEDline, PubMed and 
      google scholar studies were evaluated using SIGN assessment tool and data 
      analysis was conducted using Review Manager 5.2 on only randomised controlled 
      trials. The search terms were: arthroplasty, replacement, knee (Mesh), TKA, 
      prosthesis, patella, patellar resurfacing, patellar retaining. RESULTS: 
      Thirty-two randomised controlled studies were identified that reported the type 
      of TKA implant used: 11 used modern "patellar friendly" implants; and 21 older 
      "patellar non-friendly" implants. Among "patellar friendly" TKAs there were no 
      significant differences in anterior knee pain rates between resurfaced and 
      unresurfaced groups. Patellar resurfacing with "patellar friendly" implants had 
      significantly higher clinical (mean difference (MD) -0.77, p = 0.007) and 
      functional (MD -1.87, p < 0.0001) knee society scores (KSS) than unresurfaced 
      counterparts but these did not exceed the minimal clinically important difference 
      (MCID). Resurfacing with "patellar friendly" implants was not associated with a 
      significant (p = 0.59) difference in the Oxford knee score (OKS), in contrast 
      when a "patellar non-friendly" implant was used there was a significant 
      difference (MD 3.3, p = 0.005) in favour of resurfacing. There was an increased 
      risk of reoperation for unresurfaced TKAs with "non-patellar friendly" implants 
      (Odds ratio (OR) 1.68, 95% CI 1.03-2.74, p = 0.04), but not for unresurfaced 
      patellae with "patellar friendly" implants (OR 1.17, CI 0.59-2.30). CONCLUSIONS: 
      Patellar resurfacing in combination with a modern patellar friendly implant was 
      not associated with a lower rate of anterior knee pain, complications, or 
      reoperations compared to not resurfacing, nor did it give a clinically 
      significant improvement in knee specific function. In contrast patellar 
      resurfacing in combination with a "non-friendly" TKA implant was associated with 
      a significantly better OKS and lower reoperation rate. Implant design should be 
      acknowledged when patellar resurfacing is being considered.
CI  - Copyright (c) 2023 Elsevier B.V. All rights reserved.
FAU - Simpson, Cameron Jrw
AU  - Simpson CJ
AD  - Department of Trauma and Orthopaedics, West of Scotland, Scotland. Electronic 
      address: cameron.simpson@nhs.scot.
FAU - Ng, Nathan
AU  - Ng N
AD  - Edinburgh Orthopaedics, South-East Scotland, Scotland.
FAU - Ndou, Solomon
AU  - Ndou S
AD  - Edinburgh Orthopaedics, South-East Scotland, Scotland.
FAU - Wright, Evan
AU  - Wright E
AD  - Department of Trauma and Orthopaedics, West of Scotland, Scotland.
FAU - Yap, Ngee Jin
AU  - Yap NJ
AD  - Edinburgh Orthopaedics, South-East Scotland, Scotland.
FAU - Scott, Chloe E H
AU  - Scott CEH
AD  - Edinburgh Orthopaedics, South-East Scotland, Scotland; University of Edinburgh, 
      Scotland.
FAU - Clement, Nick D
AU  - Clement ND
AD  - Edinburgh Orthopaedics, South-East Scotland, Scotland; University of Edinburgh, 
      Scotland.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20230222
PL  - Netherlands
TA  - Knee
JT  - The Knee
JID - 9430798
SB  - IM
MH  - Humans
MH  - *Arthroplasty, Replacement, Knee/adverse effects
MH  - Knee Joint/surgery
MH  - *Knee Prosthesis
MH  - Patella/surgery
MH  - Pain/surgery
MH  - Treatment Outcome
MH  - *Osteoarthritis, Knee/surgery
OTO - NOTNLM
OT  - Meta-analysis
OT  - Patellar friendly implants
OT  - Patellar resurfacing
OT  - Randomised controlled trials
COIS- Declaration of Competing Interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2023/02/25 06:00
MHDA- 2023/04/25 06:42
CRDT- 2023/02/24 18:52
PHST- 2022/01/13 00:00 [received]
PHST- 2023/01/19 00:00 [revised]
PHST- 2023/01/28 00:00 [accepted]
PHST- 2023/04/25 06:42 [medline]
PHST- 2023/02/25 06:00 [pubmed]
PHST- 2023/02/24 18:52 [entrez]
AID - S0968-0160(23)00031-5 [pii]
AID - 10.1016/j.knee.2023.01.021 [doi]
PST - ppublish
SO  - Knee. 2023 Mar;41:329-341. doi: 10.1016/j.knee.2023.01.021. Epub 2023 Feb 22.