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Toronto, AL M5N 2M7
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Fax: 416-483-2654

Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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I've already had a knee replacement. And my pain is better. I can do more now than I could before the operation. But I'm disappointed because I still have pain along the front of my knee. The surgeon thinks it may be coming from the kneecap, which wasn't changed during the first surgery. I could have a second surgery to resurface the patella but is it worth it?

Total knee replacements have been proven to last at least 15 years. But survival of the implant and knee function are too different things. And many total knee patients report persistent knee pain and loss of function despite the new knee. Surgeons are exploring the reasons for this dilemma and looking for ways to improve results. One of those ways is to resurface the patella (knee cap) as part of the knee replacement procedure. Resurfacing the patella involves shaving and smoothing the cartilage and bone along the back of the patella. Then the surface is covered with an implant made of metal, polyethylene (plastic), or a combination of both metal and polyethylene. Many surgeons favor the all-polyethylene backing as a result of studies that have shown there are fewer problems with it. We can share with you some information from a large study done comparing total knee replacement with and without patellar resurfacing. In particular, the results of the study addressed late patellar resurfacing (meaning as a revision surgery like you are considering). They found that patellar resurfacing at the time of the total knee replacement doesn't yield any better results than putting in an implant without touching the patella. For those who had persistent pain and went back for a second surgery, patellar resurfacing was advised. Patients who had revision surgery to perform a patellar resurfacing reported a gradual improvement in painful symptoms. Along with pain relief came improved function. But overall, the group never reached a level of improvement equal to patients who had a total knee replacement without residual knee pain. At the very least, you should know patellar resurfacing can help but complete pain relief is not guaranteed.


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