Comparison of radiological and clinical assessments patellar resurfacing with retention for late stages of knee osteoarthritis performed total knee arthroplasty


  • Jong Keun Seon
  • Kamolhuja Eshnazarov
  • Murodulla Karimov
  • Eun Kyoo Song



knee osteoarthritis, total knee arthroplasty, patella resurfacing, radiological assessment, clinical outcomes


Introduction: the purpose of this prospective study was to compare radiological and clinical outcomes after total knee arthroplasty (TKA) with or without patellar resurfacing in patients with grade IV osteoarthritis on patellofemoral joint.

Materials and Methods: 123 cases with Kellgren-Lawrence grade IV osteoarthritis on patellofemoral joint were enrolled for this study. At the operating room they were randomly assigned to undergo patella resurfacing (62 cases) or patella retention (61 cases). Among them, 114 cases that could be followed for more than 2 years were included in this study (resurfacing group; 59 cases, retention group; 55 cases). Preoperative and postoperative radiological and clinical outcomes (mechanical femorotibial angles, patellar tilt, congruence angle, WOMAC score and ROM) were evaluated and compared between two groups.

Results: preoperative radiological measures show insignificant difference between patellar tilt (P = 0.13), mechanical femorotibial angles (P = 0.62) and congruence angle (P = 0.37). Despite the difference performed methods of surgery, postopera­tive radiological assessment outcomes between two groups were almost identical Patellar tilt (P = 0.47), mechanical femorotibial angles (P = 0.34) and congruence angle (P >0.05). WOMAC score after surgery was 31.7 ± 6.4 point in resurfacing group, 29.2 ± 6.9point was in retention group without significant intergroup difference. And there was no significant difference ROM in both groups respectively. There was no significant difference between two groups in mechanical axis of the lower limb and patella tilt, patella congruence.

Conclusion: obtained almost the same satisfactory radiological and clinical outcomes after patella resurfacing and retention groups after TKR allows us to conclude that, primary TKA without patellar resurfacing is a good treatment option in patients with high grade osteoarthritis of the patellofemoral joint.


Pastides PS, Shenoy R, Nathwani D. The patella in total knee replacement. Orthopedics and Trauma. 2013;27(6):372–8. doi: 10.1016/j.mporth.2013.09.003.

Schindler OS. The controversy of patellar resurfacing in total knee arthroplasty: Ibisne in medio tutissimus? Knee Surg. Sports Traumatol. Arthrosc. 2012;20(7):1227–44. doi: 10.1007/s00167-012-1985-7.

Roberts DW, Hayes TD, Tate CT, Lesko JP. Selective patellar resurfacing in total knee arthroplasty: a prospective, randomized, double-blind study. J Arthroplasty. 2015;30(2):216–22. doi: 10.1016/j.arth.2014.09.012.

Han I, Chang CB, Kang YG. Intraobserver and interobserver reliability of the assessment of the patellar articular cartilage in osteoarthritic patients undergoing total knee arthroplasty. J Arthroplasty. 2006;21(4):567–71.

Karam JA, Higuera CA, Smith EB, Sharkey PF. Patellofemoral arthritis. Operative Techniques in Orthopaedics. 2012;22(4):196–202. doi: 10.1053/j.oto.2013.01.001.

Mayman D, Bourne RB, Rorabeck CH, Vaz M, Kramer J. Resurfacing versus not resurfacing the patella in total knee arthroplasty. J Arthroplasty. 2003;18(5):541–5.

Glynn A, Huang R, Mortazavi J, Parvizi J. The impact of patellar resurfacing in two-stage revision of the infected total knee arthroplasty. J Arthroplasty. 2014;29 (7):1439–42. doi: 10.1016/j.arth.2013.07.018.

Garcia RM, Kraay MJ, Goldberg VM. Isolated resurfacing of the previously unresurfaced patella total knee arthroplasty. J Arthroplasty. 2010;25(5):754–8. doi: 10.1016/j.arth.2009.06.010.

Farr J, Lattermann Ch. Management of patellofemoral arthritis without arthroplasty. Seminars in Arthroplasty. 2009;20 (3):136–41.

Thompson NW, Ruiz AL, Breslin E, Beverland DE. Total knee arthroplasty without patellar resurfacing in isolated patellofemoral osteoarthritis. J Arthroplasty. 2001;16 (5):607–12.

Cherian JJ, Kapadia BH, Banerjee S, Jauregui JJ, Issa K, Mont MA. Mechanical, anatomical, and kinematic axis in TKA: concepts and practical applications Curr. Rev Musculoskelet. Med. 2014;7(2):89–95. doi: 10.1007/s12178-014-9218-y.

Liu ZT, Fu PL, Wu HS, Zhu Y. Patellar reshaping versus resurfacing in total knee arthroplasty — Results of a randomized prospective trial at a minimum of 7 years’ follow-up. Knee. 2012;19(3):198–20. doi: 10.1016/j.knee.2011.03.004.

Singerman R, Gabriel SM, Maheshwer CB,. Kennedyt JW. Patellar contact forces with and without patellar resurfacing in total knee arthroplasty. J Arthroplasty. 1999;14(5):603–9.

Helmy N, Anglin C, Greidanus NV, Masri BA. To resurface or not to resurface the patella in total knee arthroplasty. Clin. Orthop. Relat. Res. 2008;466(11):2775–83.

Urch SE, Tritle BA, Shelbourne KD, Gray T. Axial linear patellar displacement a new measurement of patellofemoral congruence. Am. J Sports Medicine. 2009;379(5):970–3. doi: 10.1177/0363546508328596.

Farrokhi S, O’Connell M, Fitzgerald GK. Altered gait biomechanics and increased knee-specific impairments in patients with coexisting tibiofemoral and patellofemoral osteoarthritis. Gait Posture. 2015;41(1):81–5. doi: 10.1016/j.gaitpost.2014.08.014.

Hinman RS, Lentzos J, Vicenzino B, Crossley KM. Is Patellofemoral osteoarthritis common in middle-aged people with chronic patellofemoral pain? Arthritis Care Res. 2014;66:1252–7. doi: 10.1002/acr.22274.

Katsuragi J, Sasho T, Yamaguchi S, Sato Y, Watanabe A, Akagi R, Muramatsu Y, Mukoyama S, Akatsu Y, Fukawa T, Endo J, Hoshi H, Yamamoto Y, Sasaki T, Takahashi K. Hidden osteophyte formation on plain X-ray is the predictive factor for development of knee osteoarthritis after 48 months — data from the Osteoarthritis Initiative. Osteoarthritis Cartilage. 2015;23(3):383–90. doi: 10.1016/j.joca.2014.11.026.

Schiphof D, Oei EH, Hofman A, Waarsing JH, Weinans H, Bierma-Zeinstra SM. Sensitivity and associations with pain and body weight of an MRI definition of knee osteoarthritis compared with radiographic Kellgren and Lawrence criteria: a population-based study in middle-aged female. Osteoarthritis Cartilage. 2014;22 (3):440–6. doi: 10.1016/j.joca.2013.12.017.

Merchant AC. Radiography of the patellofemoral joint. Oper. Tech. Sports Med. 1999;7:59–64.

Gomes LS, Bechtold JE, Gustilo RB. Patellar prosthesis positioning in total knee arthroplasty: a roentgenographic study. Clin. Orthop. Relat. Res. 1988;236:72–81.

Shakirov EA, Karimov MY, Hamraev ShSh. Radiological methods of diagnostics of the patellofemoral joint. Bulletin of the Association of Doctors of Uzbekistan. 2002;4:93–5.