You might find the results of a recent meta-analysis helpful. Meta-analysis means the results of all the studies published on a particular topic are pooled together and analyzed for statistical significance. This type of study is helpful when each individual study of the problem has only a few patients (or a fairly small number of patients). Without enough numbers in a study, finding statistical significance can be a challenge.
As you are finding out, there isn’t a clear consensus among surgeons about whether or not the patella should be resurfaced during the total knee replacement procedure. Resurfacing means the back of the patella is lined with a polyethylene (plastic) dome to allow it to move freely and smoothly once again. There is considerable debate among orthopedic surgeons about the benefits and disadvantages of patellar resurfacing.
In the recent meta-analysis we found, researchers reviewed randomized controlled studies reported from as early as 1995 to the present time. A total of 3,465 knee replacements were included, divided evenly into two groups: those who had patellar resurfacing as part of their knee replacement and those who did not.
The three main measures of patient outcomes included: pain, function, and patient satisfaction. Other secondary results compared were rate of reoperation, complications, operative time, and X-ray findings.
There isn’t much to report because except for rate of reoperation, there were no significant differences between the two groups. Pain levels after surgery, patient reported knee motion and function were the same, and 89 to 90 per cent of both groups were happy with the results. The rate of post-operative infection was low (between one and two per cent) for both groups. And the amount of time in surgery wasn’t different enough to be considered significant from a statistical point-of-view.
The only statistically significant difference between the two groups was a much higher rate of reoperation in the nonresurfaced group. Most of these second surgeries were done because of knee pain. Some of the patients in the patellar resurfacing group had to have additional surgery because of complications but the rate of problems was much lower in the resurfacing group compared with the nonresurfacing patients.
In theory, resurfacing should take more time and increase the risk of infection. But as this study showed, in practice this just isn’t the case. Most of the results from this meta-analysis don’t favor routine resurfacing as part of a total knee replacement. There is not clear proof that continued knee pain in patients who did not have patellar resurfacing was really due to lack of patellar resurfacing.
The decision to resurface (or not resurface) the patella as part of the knee replacement must be made together by the patient and surgeon. Surgeons must keep up with the results of studies like this one in order to consider all the current evidence available when advising and counseling patients individually.