sunrise 2#1 Debated Issue in Total Knee Arthroplasty Is… (Orthopedics This Week)
When joint replacement luminaries gather ‘round at the upcoming American Academy of Orthopaedic Surgeons (AAOS) meeting, Jay Lieberman, M.D., chair of the Department of Orthopaedic Surgery at the Keck School of Medicine of USC and outgoing president of the American Academy of Hip and Knee Surgeons, will be stirring the pot with a panel discussion on “Great Debates in Total Knee Arthroplasty.”
Dr. Lieberman told OTW, “One of the biggest issues in the total joint replacement is whether or not to resurface the patella. Generally speaking, in the U.S., the majority of the patellas are resurfaced; in Europe it is the opposite.”
“There are three ‘camps:’ those who believe that all patellas should be resurfaced, those who resurface virtually no one, and those who do selective resurfacing. Those who do selective resurfacing make their decisions based on the thickness of the patella, the extent of the degenerative changes, and the overall size and activity level of the patient. Some surgeons are avoiding patellar resurfacing on younger, active patients because they are concerned about loosening and fractures. This apprehension is understandable because we do not have great solutions for treating a loose or fractured patella.”
“Although randomized controlled trials (RCTs) indicate that the results are equivalent between those resurfaced and those not, 10% of patients who do not undergo resurfacing have some type of pain and may require revision. However, just resurfacing the patella may not eliminate the pain. Patients with a resurfaced patella may also complain of pain. Some patients have mild anterior knee pain going up and down stairs, something that may occur because the person’s quadriceps and hamstrings are not strong enough.”
“As for patient selection, one should consider the degeneration of the joint surface of the patella, the thickness of the patella, the patient’s diagnosis, age, weight, and activity level.”
“Going forward, total joint registries will give us more data about how patients are faring; more multicenter RCTs will help us ask more specific questions. Some of these might be: ‘Is it better to avoid resurfacing the patella in younger, active males over 250 pounds?’ ‘What is the outcome of those with a thinner patella who are resurfaced versus those who are not?’ Time—and research—will tell.”