Total Knee Arthroplasty without patellar resurfacing

ABSTRACT

Patello-femoral problem is one of the common complications in total knee arthroplasty and whether to replace the patella or retain it has long been controversial in order to prevent the complications. 43 cases (35 patients) of total knee arthroplasty with patellar retention performed by a single surgeon between August 1993 and August 2000 were reviewed retrospectively. The follow-up period averaged 54 months (range, 24-120 months). The whole cases were divided into three groups according to the preoperative radiographs. Group A was normal patella (10 knees), Group B was borderline arthritic patella (20 knees), and Group C was severely deformed patella (13 knees). All of 43 knees, regardless of preoperative radiological degree of arthritis received patelloplasty including removal of osteophytes, subchondral shaving and lateral retinacular release was performed in 20 knees (47%). Each groups was evaluated in terms of the objective criteria of anterior knee pain, range of motion, stair climbing ability, and roentgenographic findings. All 35 patients were diagnosed as osteoarthritis in 29 and rheumatoid arthritis in 6. American Knee Society Score (KSS) was assessed for the clinical analysis and lateral patella shift and patella tilt were assessed for roentgenographic analysis. The mean Knee Society Score at final follow-up was 94 in group A, 93 in group B, and 94 in group C. Mild anterior knee pain was reported in 9.3% (Group A 2 cases, Group C 2 cases). patellar tilt was significantly higher in C group (oneway ANOVA test, p=0.01), representing that advanced patello-femoral arthritis caused increased patellar tilt. There was neither significant difference in terms of range of motion, and stair climbing ability nor of patellar shift among all three groups. TKA with patelloplasty, not resurfacing the patella, provided satisfactory results without significant problems regardless of the preoperative degree of patello-femoral arthritis.