Patellar Resurfacing versus Non-resurfacing in Totol Knee Arthroplasty: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 LI Lianhua , SUN Tianshen , WANG Jing , ZHU Bin , WU Jun , YAO Jianhua , TANG Yu

Department of Orthopedics, General Hospital of Beijing Military Area Command of Chinese PLA, Beijing 100700, China;

Corresponding author：

LI Lianhua, Email: lilianhua@medmail.com.cn

Keywords：

Total knee arthroplasty; Patella; Resurfacing; Randomized controlled trial; Systematic review

DOI：

10.7507/1672-2531.20090188

Video：

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Objective 　To compare the treatment effect of patellar resurfacing versus patellar non-resurfacing in total knee arthroplasty.
Methods 　We identified eligible studies in PubMed (1950 to 2008.6), OVID MEDLINE (1950 to 2008.6), OVID CINAHL (1950 to 2008.6), OVID EBM (2nd Quarter 2008), CBMdisk (1978 to 2008.6), and CNKI (1981 to 2008.6), and handsearched some Chinese orthopedic journals to identified randomize controlled trials (RCTs) comparing patellar resurfacing versus patellar non-resurfacing in total knee arthroplasty. Data were extracted and methodological quality was critically assessed by two reviewers independently. Meta-analyses were performed using Stata 10.0 software. Outcomes of interest included the number of reoperations for patellofemoral problems, the prevalence of postoperative anterior knee pain, and the improvement in HSS knee score.
Results 　Thirteen RCTs involving 1 566 patients were included. The scores of methodological quality respectively were more than 13. The results of meta-analyses showed that patellar resurfacing could decrease the re-operation rate for patellofemoral problems (RR=0.30, 95%CI 0.14 to 0.62, P lt;0.01). The rate of postoperative anterior knee pain and the improvement in HSS knee score were comparable between patellar resurfacing and patellar non-resurfacing.
Conclusion 　The outcome identified is re-operations for patellofemoral problems. The resurfaced patella performs better, and we find an increased relative risk for re-operation when the patella is left un-resurfaced. No differences are observed between the two groups for the prevalence of postoperative anterior knee pain, and the improvement in HSS knee score. Further well-designed and large-scale RCTs are required to determine the effects of patellar resurfacing and non-resurfacing on these outcomes.

Citation： LI Lianhua,SUN Tianshen,WANG Jing,ZHU Bin,WU Jun,YAO Jianhua,TANG Yu. Patellar Resurfacing versus Non-resurfacing in Totol Knee Arthroplasty: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(10): 1060-1066. doi: 10.7507/1672-2531.20090188 Copy

1.	Barrack RL, Burak C. Patella in total knee arthroplasty. Clin Orthop Rel Res, 2001, 389: 62.
2.	Kelly MA. Patellofemoral complications following total knee arthroplasty. Instruct Course Lect, 2001, 50: 403.
3.	Barrack RL, Bertot AJ, Wolfe MW, et al. Patellar resurfacing in total knee arthroplasty: a prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Am, 2001, 83: 1376.
4.	Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br, 1996, 78(2): 226-228.
5.	Schroeder-Boersch H, Scheller G, Fischer J, et al. Advantages of patellar resurfacing in total knee arthroplasty. Two-year results of a prospective randomized study. Arch Orthop Trauma Surg, 1998, 117(1-2): 73-78.
6.	Newman JH, Ackroyd CE, Shah NA, et al. Should the patella be resurfaced during total knee replacement? The Knee, 2000, 7(1): 17-23.
7.	Barrack RL, Bertot AJ, Wolfe MW, et al. Patellar resurfacing in total knee arthroplasty. A prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Am, 2001, 83-A(9): 1376-1381.
8.	Wood DJMSF, Smith AJB, Collopy DMF, et al. Patellar Resurfacing in Total Knee Arthroplasty: A Prospective, Randomized Trial. Journal of Bone & Joint Surgery - American Volume, 2002, 84-A(2): 187-193.
9.	Kordelle J, Schleicher I, Kaltschmidt I, et al. [Patella resurfacing in patients without substantial retropatellar knee pain symptoms?]. Z Orthop Ihre Grenzgeb, 2003, 141(5): 557-562.
10.	Mayman D, Bourne RB, Rorabeck CH, et al. Resurfacing versus not resurfacing the patella in total knee arthroplasty: 8- to 10-year results. J Arthroplasty, 2003, 18(5): 541-545.
11.	Waters TS, Bentley G. Patellar resurfacing in total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am, 2003, 85-A(2): 212-217.
12.	Burnett RS, Haydon CM, Rorabeck CH, et al. Patella resurfacing versus nonresurfacing in total knee arthroplasty: results of a randomized controlled clinical trial at a minimum of 10 years’ followup. Clin Orthop Relat Res, 2004(428): 12-25.
13.	Gildone A, Manfredini M, Biscione R, et al. Patella resurfacing in posterior stabilised total knee arthroplasty: a follow-up study in 56 patients. Acta Orthop Belg, 2005, 71(4): 445-451.
14.	Campbell DG, Duncan WW, Ashworth M, et al. Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. J Bone Joint Surg Br, 2006, 88(6): 734-739.
15.	Myles CM, Rowe PJ, Nutton RW, et al. The effect of patella resurfacing in total knee arthroplasty on functional range of movement measured by flexible electrogoniometry. Clin Biomech (Bristol, Avon), 2006, 21(7): 733-739.
16.	Smith AJ, Wood DJ, Li MG. Total knee replacement with and without patellar resurfacing: a prospective, randomised trial using the profix total knee system. J Bone Joint Surg Br, 2008, 90(1): 43-49.
17.	Kurup H, Hossain M, Andrew JG. Plating versus intramedullary nailing for humeral shaft fractures in adults. Cochrane Database of Systematic Reviews, 2007, Issue 3.
18.	Breslow NE, Day DE. Combination of results from a series of 2x2 tables; control of confounding. In: Statistical methods in cancer research. Vol. 1. The analysis of case-control studies. Lyon, France: International Agency for research on cancer, 1980, 136-146.
19.	Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
20.	Freeman MA, Samuelson KM, Elias SG, et al. The patellofemoral joint in total knee prostheses design considerations. J Arthroplasty, 1989, 4 suppl: S69-S74.
21.	Le Lorier J, Gregoire G, Benhaddad A, et al. Discrepencies between meta-analyses and subsequent large randomized, controlled trials. N Engl J Med, 1997, 337: 536-542.
22.	Chan AW, Hrobjartsson A, Haahr MT, et al. Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles. JAMA, 2004, 291: 2457-2465.

1. Barrack RL, Burak C. Patella in total knee arthroplasty. Clin Orthop Rel Res, 2001, 389: 62.
2. Kelly MA. Patellofemoral complications following total knee arthroplasty. Instruct Course Lect, 2001, 50: 403.
3. Barrack RL, Bertot AJ, Wolfe MW, et al. Patellar resurfacing in total knee arthroplasty: a prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Am, 2001, 83: 1376.
4. Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br, 1996, 78(2): 226-228.
5. Schroeder-Boersch H, Scheller G, Fischer J, et al. Advantages of patellar resurfacing in total knee arthroplasty. Two-year results of a prospective randomized study. Arch Orthop Trauma Surg, 1998, 117(1-2): 73-78.
6. Newman JH, Ackroyd CE, Shah NA, et al. Should the patella be resurfaced during total knee replacement? The Knee, 2000, 7(1): 17-23.
7. Barrack RL, Bertot AJ, Wolfe MW, et al. Patellar resurfacing in total knee arthroplasty. A prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Am, 2001, 83-A(9): 1376-1381.
8. Wood DJMSF, Smith AJB, Collopy DMF, et al. Patellar Resurfacing in Total Knee Arthroplasty: A Prospective, Randomized Trial. Journal of Bone & Joint Surgery - American Volume, 2002, 84-A(2): 187-193.
9. Kordelle J, Schleicher I, Kaltschmidt I, et al. [Patella resurfacing in patients without substantial retropatellar knee pain symptoms?]. Z Orthop Ihre Grenzgeb, 2003, 141(5): 557-562.
10. Mayman D, Bourne RB, Rorabeck CH, et al. Resurfacing versus not resurfacing the patella in total knee arthroplasty: 8- to 10-year results. J Arthroplasty, 2003, 18(5): 541-545.
11. Waters TS, Bentley G. Patellar resurfacing in total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am, 2003, 85-A(2): 212-217.
12. Burnett RS, Haydon CM, Rorabeck CH, et al. Patella resurfacing versus nonresurfacing in total knee arthroplasty: results of a randomized controlled clinical trial at a minimum of 10 years’ followup. Clin Orthop Relat Res, 2004(428): 12-25.
13. Gildone A, Manfredini M, Biscione R, et al. Patella resurfacing in posterior stabilised total knee arthroplasty: a follow-up study in 56 patients. Acta Orthop Belg, 2005, 71(4): 445-451.
14. Campbell DG, Duncan WW, Ashworth M, et al. Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. J Bone Joint Surg Br, 2006, 88(6): 734-739.
15. Myles CM, Rowe PJ, Nutton RW, et al. The effect of patella resurfacing in total knee arthroplasty on functional range of movement measured by flexible electrogoniometry. Clin Biomech (Bristol, Avon), 2006, 21(7): 733-739.
16. Smith AJ, Wood DJ, Li MG. Total knee replacement with and without patellar resurfacing: a prospective, randomised trial using the profix total knee system. J Bone Joint Surg Br, 2008, 90(1): 43-49.
17. Kurup H, Hossain M, Andrew JG. Plating versus intramedullary nailing for humeral shaft fractures in adults. Cochrane Database of Systematic Reviews, 2007, Issue 3.
18. Breslow NE, Day DE. Combination of results from a series of 2x2 tables; control of confounding. In: Statistical methods in cancer research. Vol. 1. The analysis of case-control studies. Lyon, France: International Agency for research on cancer, 1980, 136-146.
19. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
20. Freeman MA, Samuelson KM, Elias SG, et al. The patellofemoral joint in total knee prostheses design considerations. J Arthroplasty, 1989, 4 suppl: S69-S74.
21. Le Lorier J, Gregoire G, Benhaddad A, et al. Discrepencies between meta-analyses and subsequent large randomized, controlled trials. N Engl J Med, 1997, 337: 536-542.
22. Chan AW, Hrobjartsson A, Haahr MT, et al. Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles. JAMA, 2004, 291: 2457-2465.

Chinese Journal of Evidence-Based Medicine

Patellar Resurfacing versus Non-resurfacing in Totol Knee Arthroplasty: A Systematic Review

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