Article
Patella resurfacing in total knee replacement
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Authors
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E. Hille
- Allgemeines Krankenhaus Eilbek, Landesbetrieb Krankenhaeuser Hamburg, Abteilung für Orthopaedie und Unfallchirurgie, Hamburg
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S. Dries
- Hamburg
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F. Lampe
- Hamburg
| Published: | June 13, 2005 |
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Outline
Text
Introduction
Whether or not to resurface the patella in total knee replacement ist still controversial. A review of the literature, consideration of biomechanical results and the own experience is presented.
Patients, Material and Method
Randomised controlled trials and bilateral comparative trials of the past 15 years were taken into account. Complications reported in these studies are considered regarding severity and necessity for revision surgery. With regard to the biomechanical role of the patella, pathophysiology of patellar maltracking is also considered.
Results
Randomised controlled trials of the 1990s showed better performance of TKR without patellar resurfacing, while studies published in the current decade presented better results with patellar resurfacing. Data from the swedish TKR registry revealed that the revision rate for patellar problems was comparable (0,9% vs. 0,7%) for both approaches, while there were more complex revision procedures after resurfacing.
Conclusion
The patella is an alignment detector. It indicates (by means of pain / radionuclide uptake) whether there is balance or imbalance of the thigh and lower leg. The femoro-tibial alignment turns the balance. Surgery for patellar pain has to focus more on femoro-tibial alignment than on the patellar side. The problem is not to resurface (with the possibility of technical, and certainty of biomechanical failure) or not to resurface the patella, but to consider the kinematic principles by proper alignment of the femoral and tibial implants.
