There has been no universal agreement so far regarding the necessity of patellar resurfa-cing in total knee art hroplasty. As resurfacing has been reported to be associated with high incidence of com-plications, we undertook a prospective study to evaluate the functional out-come of twenty one patients (22 knees =22cases )who had no patellar resurfa-cing during knee replacement. The underlying diagnosis was osteoarthri-tis in twenty cases and rheumatoid arthritis in two cases.
The average age was 65 years (range 54 - 75 years), there were six males and fifteen females(one was bilateral), the average period of follow up was 28 months (range 6 months - 36 months), patients were classified into three groups according to the grade of the patellar cartilage detected intraopera-tively. Preoperative and final assess-ment were done according to the Hospital for special surgery (HSS) knee scoring system and the patellar scor-ing system. Excellent and good results were obtained in nineteen eases (86.4%). The mean HSS score improved from 43.4 preoperatively to 80.9 post-operatively and the mean patellar score improved from 12.6 preopera-tively to 24.6 postoperatively. When we compared the final results in the three groups of patients we found that the grade of the patellar
Orthopaedic Department, Benha Faculty of Medicine Zagazig University
Vol. 36, No, 1, January 2001
Adel H. Adawy . M.D
cartilage have played an. important role in the final outcome. Results in patients with grade II patellar carti-lage were better than grade III and both were much more superior to pa-tients with grade TV. We concluded that patellar resurfa-cing should not be a routine step in knee replacement particularly in pre-sence of satisfactory patellar articular cartilage. The issue of whether or not to resurface the patella during total knee replacement remains controversial. Many of the ortho-pedic surgeons point out that patellar resurfacing is a logical step in total knee replacement and it gives predictable re-sults(1). Others reported several complications that occurred only or were much more common with resurfaced patella. These complications included patellar fracture, patellar subluxation or dislocation, exten-sor mechanism disruption and component wear, loosening or dissociation. (2'3'4) Because of this potential for major complications, some surgeons have stopped resurfacing the patella. Soudry et a1(5) reported that the results were the same whether the patella had been resurfaced or not, except that the patient who did not have resurfacing had difficulty in climbing stairs. Insall et al, Soudry et a1(5), and Lombardi et al") reported that patellar resurfacing was associated with major complications and they recommended that it should not be routinely performed in patients who are over weight, very active and relatively young.
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