Indications for Patellar Resurfacing in Total Knee Arthroplasty

The controversy about whether to resurface the patella or to leave the native patella unresurfaced continues to be debated by orthopaedic surgeons performing total knee arthroplasties 1. When the original total knee prostheses were designed, the patellofemoral articulation was not taken into consideration as a potential source of pain, and the results were complicated by patellofemoral symptoms despite an otherwise well-performed knee arthroplasty. Subsequent designs incorporated a femoral flange for the patellofemoral articulation and provided the option for patellar resurfacing. These early implants were not designed to accommodate the native patella in an anatomic fashion during the range of motion, and resurfacing of the patella was recommended. Complications related to patellar resurfacing became a primary concern, however, and have been associated with the variable revision rates often reported after total knee arthroplasty. Subsequent modifications in implant design have been made to offer the surgeon the option of leaving the patella unresurfaced. Increased awareness of component orientation and rotation has also improved the results with regard to the patellofemoral articulation after total knee arthroplasty 2. Numerous clinical trials have been done to help clarify the indications for patellar resurfacing. Unfortunately, there is little consensus, and surgeon preference remains the primary variable. Despite the numerous trials, there are three basic strategies: always resurface, never resurface, or selectively resurface the patella.