Patellar Resurfacing in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

Background: The management of the patella during total knee arthroplasty (TICS) remains controversial. The aim of this study is to evaluate the evidence regarding the use of patellar resurfacing in TICS. Methods: A meta-analysis of randomized controlled trials (RCTs) was performed to compare outcomes between knees receiving patellar resurfacing vs those not receiving resurfacing during primary TICS. Outcomes of interest were the Knee Society Scores, reoperation rates, anterior knee pain, patient satisfaction, Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score subscores, and range of motion. Results: Twenty RCTs met all eligibility criteria and were included in the analysis. There were statistically significant differences favoring the resurfaced group in the knee component and functional component of Knee Society Scores that were not clinically significant. There was an increased risk of reoperation among knees that did not receive resurfacing with number needed to treat to prevent one case of reoperation of 25 knees (for reoperation for any reason) and 33 knees (for reoperation for anterior knee pain). There were no statistically significant differences in any other outcomes. Conclusion: The only clear relationship is that knees that do not receive patellar resurfacing are more likely to receive reoperation, most often for secondary resurfacing. However, the disease burden of differing complication profiles associated with resurfacing and nonresurfacing groups remains unclear. Continuing to collect data from large, well-designed RCTs would be beneficial in guiding management of the patella during TICS. (C) 2019 Elsevier Inc. All rights reserved.