Patellar resurfacing practices in primary total knee replacement: A survey of BASK members

Primary total knee replacement (TKR) may be performed with or without patellar resurfacing. There are advantages and disadvantages to each approach [1]. Of 1,100,000 primary TKRs in the National Joint Registry, 38% underwent patellar resurfacing [2]. The rates of patellar resurfacing are steadily increasing, in 2011, 36% of primary TKRs had a patellar resurfacing and in 2019, 43% had a patellar resurfacing [3]. There is good evidence that always performing patellar resurfacing (compared with never resurfacing) results in lower revision rates within 10 years after TKR, with routine patellar resurfacing also being cost-effective given fewer patients need further surgery in the long-term [4]. In The National Institute for Health and Care Excellence (NICE) guidance published in June 2020, always offering patellar resurfacing in TKR was recommended based on their assessment of the currently available evidence [5]. However there is no high quality evidence comparing always versus selective patellar resurfacing in primary TKR, with NICE recommending a randomised controlled trial (RCT) to compare these strategies [5]. Selective patellar resurfacing may potentially improve outcomes compared with always performing patellar resurfacing by only resurfacing the subgroup of patellas which surgeons judge are at higher risk of causing pain in the future (if they were not resurfaced); and conversely by not resurfacing those patients where the surgeon thinks that resurfacing is not needed, or would not result in an increased risk of complications, there are potential cost-savings from decreased theatre time and patella implant costs. We surveyed BASK members to determine (1) current patellar resurfacing practices in primary TKR, and (2) the feasibility of performing a future RCT of always versus selective patellar resurfacing.