Patellar resurfacing as a second stage procedure for persistent anterior knee pain after primary total knee arthroplasty
Total knee arthroplasty (TKA) is an effective procedure in the treatment of primary osteoarthritis of the knee. The management of persistent anterior knee pain (AKP) is one of the major unsolved problems after TKA. The aim was to evaluate the clinical outcome after patellar resurfacing as a second stage procedure for AKP after TKA.
22 patients (60 years at the time of TKA) who underwent resurfacing of the patella (mean follow-up 62 months) were retrospectively reviewed. The average period between TKA and patellar resurfacing was 26 months. Inclusion criteria were persistent AKP after primary TKA, without improvement after conservative therapy. Patients were symptomatic during daily activities, such as kneeling, during sports and especially in ascending and descending stairs. Assessment was done using the Knee Society Score (KSS, 0-100). Patient’s satisfaction was evaluated by a custom-made questionnaire including three grades from satisfied to partially satisfied and not satisfied.
The mean KSS and the mean functional score (subscale) improved significantly from 60 to 77 and from 43 to 60, respectively. Eight patients (36%) indicated a good result, eight felt satisfied, six were dissatisfied (27%) and reported persistent AKP. Three of the latter patients were revised.
The treatment of AKP poses a significant challenge in the management of TKA patients. The decision whether or not to resurface has to be discussed very critically with the patient. Secondary resurfacing of the patella after TKA cannot be considered a good option.> From: Daniilidis et al., Int Orthop 36 (2012) 1181-1183. All rights reserved to Springer-Verlag.