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Disclosures
- Zimmer-consultant,royalties
- Pacira-consultant
- Acuitive Technologies-consultant
- Healthtrust-consultant
- Mallinkrodt-speakers bureau
- Vox Telehealth-advisory board
Patellar Resurfacing TKA Always! Michael Kelly, M.D Chairman - - PowerPoint PPT Presentation
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
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Patellar Replacement?
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Historically - 1970’s
Total Condylar Prosthesis
- Patello-femoral articulation
- Patellar component
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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
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Resurfaced vs. Natural Patella No significant difference: 10% Anterior Knee Pain
Keblish PA, et al. JBJS 1994 Barrack RL, et al. JBJS 1997
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Patellar Complications
Patellar fracture Patellar instability Extensor mechanism disruption Patellar component wear Patellar component loosening Patellar component disassociation
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Patellar Clunk
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Patellar Clunk
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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
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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
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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
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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
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Patellar Resurfacing TKA ? Meta-Analyses
- Nonresurfacing Patella Primary TKA:
- Increased incidence anterior knee pain
- Increased incidence reoperation for PF issues
- Poss ? Less pt satisfaction
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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
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Patellar Resurfacing
Complications Minimal When Done Right 1% Revision Rate
Barrack RL, et al. JBJS 2001
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Results are Technique Dependent
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Patellar Thickness
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Fixation Holes
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Bevel Cut
Rosen, Scuderi: Tech. in Knee Surg, #1, 2002
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Bevel Cut
Rosen, Scuderi: Tech. in Knee Surg, #1, 2002
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Tendon Debridement
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Patellar Tracking
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Prosthesis Design
Anatomic femoral components Improved trochlear recess
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Prosthesis Design
Use “Friendly” Trochlea Patella must track properly
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Patella Design
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