Are the Grade and Location of Existing Patellar Cartilage Lesions Related to Outcomes of Mobile-bearing TKA without Patellar Resurfacing?

At every follow-up time point, PROMs did not differ significantly according to the grade or location of the cartilage lesion.

Participants and Methods

165 patients with OA, comprising 186 knees without patellar resurfacing. An observational study of cemented mobile-bearing TKA compared WOMAC, Knee Society and HSS scores, patellar tilt and height by cartilage-lesion grade and location. Assessments were performed at 2, 4, 6 and 8 years after surgery.

The order in which you read the painting.

Skyline imaging after TKA with patellar retention. It illustrates imaging findings, not a comparison of efficacy with other procedures. The study compared cartilage-lesion grade and location in retained patellae with long-term PROMs. Without a resurfacing control, it cannot show patellar retention is better or equivalent. A single implant system and limited direct assessment of anterior knee pain constrain interpretation.

Main Findings

At every follow-up, PROMs did not differ significantly by cartilage-lesion grade or location. Patellar tilt and height likewise did not differ significantly by lesion grade. The abstract did not provide group effect sizes or equivalence margins.

The point of reading on surgery

Among selected patients whose patellae were retained, cartilage grade alone had limited value for predicting outcomes. This does not support recommending non-resurfacing in every TKA.

Limitations

These results are from mobile-bearing TKA with the patella retained. Patellar retention and resurfacing were not compared in a randomized trial, and the absence of a significant difference does not establish equivalence between the two treatments. The paper was published online in 2023 and in a journal issue in 2024.

Let's put it briefly.

What did this study confirm?

At every follow-up time point, PROMs did not differ significantly according to the grade or location of the cartilage lesion.

Can it be applied directly to individual patients' treatment decisions?

Keywords

Articular cartilage
Patella
Total knee arthroplasty
Arthroplasty, Replacement, Knee
Osteoarthritis, Knee
Knee Prosthesis
Cartilage
Postoperative Period

Abstract · Original text

Do Weon Lee, Du Hyun Ro, Hyuk-Soo Han, Myung Chul Lee. Patella Cartilage Status Does Not Affect the Clinical Outcomes of Non-resurfaced Patella in Mobile-Bearing Total Knee Arthroplasty. Clinics in orthopedic surgery. 2024;16(2):242-250. doi:10.4055/cios22253.

BACKGROUND

During total knee arthroplasty (TKA), patellar retention is performed when the cartilage is fairly well preserved and the thickness of the patella is relatively thin. However, clinical outcomes of the non-resurfaced patella in TKA according to the cartilage status are lacking in the literature. The purpose of this study was to compare patient-reported outcome measures (PROMs) according to the grade and location of the patellar cartilage lesion in TKA patients.

METHODS

The outcomes of 165 osteoarthritis patients (186 knees) who underwent cemented mobile-bearing TKA without patellar resurfacing were assessed and classified according to the grade and location of the patellar cartilage lesion. PROMs using the Western Ontario and MacMaster Universities Osteoarthritis index, the Knee Society Score (Knee Society Function Score and Knee Society Knee Score), and the Hospital for Special Surgery score were evaluated preoperatively and at postoperative 2, 4, 6, and 8 years. The correlations between PROMs and the grade and location of the cartilage lesion were assessed. Additionally, radiologic outcomes including the patellar tilt angle and patellar height were assessed and their correlation with the grade of cartilage lesion was analyzed. Analysis of variance was used to determine statistical significance.

RESULTS

There was no significant difference between PROMs according to the grades and locations of cartilage lesions at any postoperative follow-up. Radiologic parameters also showed no significant differences according to the grades of patellar cartilage lesions.

CONCLUSIONS

The grade and location of the patellar cartilage lesion had no influence on clinical outcomes in mobile-bearing TKA with patellar retention at short- and long-term follow-up.

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The original paper.

Patella Cartilage Status Does Not Affect the Clinical Outcomes of Non-resurfaced Patella in Mobile-Bearing Total Knee Arthroplasty

Do Weon Lee, Du Hyun Ro, Hyuk-Soo Han, Myung Chul Lee
Clinics in Orthopedic Surgery · 2024

DOI · 10.4055/cios22253 PubMed Based data

The first one examined.