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Controversy over Patellar Resurfacing in Knee Replacement

Little by little, total knee replacements (TKRs) have changed for the better. In this report, two surgeons from Canada review the changes made in the knee cap or patella during TKR.

Early in the history of TKR surgery, the patella was ignored. But then knee pain in more than half the patients got the surgeons' attention. Arthritis causes changes in the joint and also on the back of the patella. Damage to the patella must be taken care of when the joint is replaced. This is called patellar resurfacing.

At first a flat piece of metal was put on the bottom of the femur (thighbone) where it moves against the patella. This was called a femoral flange. Patients still had pain in front of the knee over the patella. Later the flange was curved, and a button was added to the back of the patella. The button helps the patella track up and down against the flange.

Is patellar resurfacing always needed? That is the question these researchers asked. They reviewed published reports and compared patients who had their patella resurfaced with those who didn't.

The authors found that patellar resurfacing seems like a good idea for most TKRs. Patients younger than 60 may not need it. Patellar resurfacing may also be unnecessary if the cartilage on the patella is in good shape. The same is true if the patella is tracking well.

References: Robert B. Bourne, MD, FRCSC, and R. Stephen J. Burnett, MD, FRCSC. The Consequences of Not Resurfacing the Patella. In Clinical Orthopaedics and Related Research. November 2004. Vol. 428. Pp. 166-169.

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