Patellar Resurfacing TKA Always! Michael Kelly, M.D Chairman - PowerPoint PPT Presentation

Patellar Resurfacing TKA Always! Michael Kelly, M.D Chairman Orthopaedic Surgery Hackensack University Medical Center

Disclosures • Zimmer-consultant,royalties • Pacira-consultant • Acuitive Technologies-consultant • Healthtrust-consultant • Mallinkrodt-speakers bureau • Vox Telehealth-advisory board

Patellar Replacement?

Historically - 1970’s Total Condylar Prosthesis • Patello-femoral articulation • Patellar component

Literature Not Conclusive (early 1990s) Keblish PA, et al. JBJS 1994 Bourne RB, et al. CORR, 1995 Feller JA, et al. JBJS, 1996 Barrack RL, et al. JBJS 1997

Resurfaced vs. Natural Patella No significant difference: 10% Anterior Knee Pain Keblish PA, et al. JBJS 1994 Barrack RL, et al. JBJS 1997

Patellar Complications Patellar fracture Patellar instability Extensor mechanism disruption Patellar component wear Patellar component loosening Patellar component disassociation

Patellar Clunk

Patellar Clunk

Patellar Complications Older literature not relevant • 50% revisions related to patella complications Improved component designs Improved surgical techniques Dennis: Am. J Knee Surg.: 5, 1992

Burnett et al: • BTKA-prospective randomized 64 TKAs • Living pts. f/ u minimum 10 yrs • Anterior knee pain 17% with/ without resurfacing CORR: 464-2007

Wood DJ et al: • Prospective randomized study-220 TKAs • f/ u mean 48 months (36-79 mons) • 12% non resurfaced 10% resurfaced had revision surgery related to PF joint • Resurfaced group had less anterior knee pain and better stair descent JBJS 84-A #2:2002

Patellar Resurfacing TKA ? Meta-Analyses • Pilling RWD et al:JBJS 94-A #24:2012 • Parvizi J et al:CORR 438:2005 • He Ji-Ye et al:The Knee 18 :2011 • Pakos EE et al:JBJS 87A#7:2005 • Abdel M et al:Curr Rev Musculoskel. Med (7) 2014

Patellar Resurfacing TKA ? Meta-Analyses • Nonresurfacing Patella Primary TKA: • Increased incidence anterior knee pain • Increased incidence reoperation for PF issues • Poss ? Less pt satisfaction

Resurfacing Unresurfaced Patella Primary TKA • Parvizi J et al: • 39 pts (41 tka)-secondary patellar resurfacing TKA • 20% dissatisfied with their result • Knee scores improved whole cohort Garcia R et al:Jnk • 17 pts (17 tka)-secondary patellar resurfacing • 47% anterior knee pain & dissatisfied with results • Knee scores improved whole cohort Parvizi Jnl Arthro vol 27 2012 Garcia Jnl Arthro vol 25 2010

Patellar Resurfacing Complications Minimal When Done Right 1% Revision Rate Barrack RL, et al. JBJS 2001

Results are Technique Dependent

Patellar Thickness

Fixation Holes

Bevel Cut Rosen, Scuderi: Tech. in Knee Surg, #1, 2002

Bevel Cut Rosen, Scuderi: Tech. in Knee Surg, #1, 2002

Tendon Debridement

Patellar Tracking

Prosthesis Design Anatomic femoral components Improved trochlear recess

Prosthesis Design Use “Friendly” Trochlea Patella must track properly

Patella Design

Patellar Resurfacing Surgeon Experience