No difference in 1-year improvement of patient-reported physical functioning and pain between resurfaced and unresurfaced patellae: analysis of 17,224 primary total knee arthroplasties in the Dutch Arthroplasty Register

Abstract

Background and purpose - Whether or not to resurface the patella during primary total knee arthroplasty (TKA) remains controversial. We aimed to investigate the asso-ciation between patellar resurfacing and patient-reported outcome measure (PROM) improvement 1 year postopera-tively in terms of physical functioning and pain following TKA. Patients and methods - We performed an observa-tional study using the Dutch Arthroplasty Register on pro-spectively collected PROM data (n = 17,224, years 2014- 2019). Preoperative and 1-year PROM pain scores (NRS at rest; during activity) and physical functioning scores (KOOS-PS, OKS) were examined. Stratification was per-formed for cruciate-retaining (CR) and posterior-stabilized (PS) and for the 4 most frequently used TKA implants in the Netherlands (Nexgen, Genesis II, PFC/Sigma, Vanguard) using multivariable linear regression adjusting for age, ASA classification, preoperative general health (EQ VAS), and preoperative PROMs. Results - 4,525 resurfaced and 12,699 unresurfaced patellae in TKA were analyzed. Overall, no significant differ-ence in 1-year PROM improvement was found between the 2 groups. In CR TKAs, resurfacing resulted in less improve-ment in KOOS-PS and OKS (adjusted difference between groups (B) -1.68, 95% confidence interval (CI) -2.86 to -0.50 and B -0.94, CI -1.57 to -0.31. Fewer improvements for patellar resurfacing in TKA were found for the Genesis TKA on NRS pain at rest (B -0.23, CI-0.40 to -0.06) and Oxford knee score (B -1.61, CI -2.24 to -0.98). Conclusion - No significant differences were found in 1-year improvement of physical functioning and pain between TKA with resurfaced and unresurfaced patellae.