RESURFACING OR RETAINING THE PATELLA IN TOTAL KNEE ARTHROPLASTY: A MOVEMENT ANALYSIS STUDY.

Abstract

INTRODUCTION: In total knee arthroplasty (TKA) it still remains undecided whether the patella should be resurfaced or not. This study used two accelerometer based motion analysis systems to study if functional tests are able to detect a difference in patients with or without a resurfaced patella.

METHOD: Retrospective study of a cohort of 53 unilateral TKA patients (Stryker Scorpio). With one surgeon always resurfacing and the other one routinely retaining the patella, patients were divided into a resurfaced group (RS, n=31) and a non-resurfaced group (NR, n=22).

Patients were clinically assessed for 2 years using the Knee Society Score (KSS). At final follow-up patients were assessed once using two accelerometer based motion tests (Dynaport Knee Test and Minimod Gait Test; McRoberts, Netherlands). The knee score is composed of four sub scores (Locomotion, Rise & Descend, Transfers, Lift & Move). The gait test records walking parameters such as step frequency, length and speed plus various parameters of step asymmetry, irregularity and efficiency. Statistical analysis was performed using the van Elteren’s test (KSS data) and a stratified regression analysis (Dynaport and Minimod data)

RESULTS: The mean pre-op KSS was not different between the groups (RS=42.7+/−16.5, NS=50.5+/−13.8, p=0.08). Differences remained non-significant post-op at three months (RS=42.7+/−16.5, NS=50.5+/−13.8, p=0.08), at final follow-up (RS=42.7+/−16.5, NS=50.5+/−13.8, p=0.08) and regarding total improvement (RS=8.7, NS=5.1, p=0.29).

The Dynaport knee test showed a significant functional advantage for patella resurfacing (RS=44.1+/−12.1, NR=39.7+/−19.2, p=0.04). The sub score Rise & Descend showed the largest advantage for patella resurfacing (RS=44.7, NR=39.7, p=0.04). The other sub scores also favored resurfacing but were not significant. The Minimod Gait test favoured RS in most parameters but at non-significant levels.

DISCUSSION: Using the KSS it was not possible to identify resurfacing or retaining the patella as the superior choice in TKA. However, using performance based tests it was possible to measure significant differences in favour of patella resurfacing but only when the motion tasks were most demanding and depending on patella-femoral function such as during Rise & Descend (stair climbing, slope walking, stepping onto blocks). This indicates a relevant functional benefit of patella resurfacing for the patient. Functional parameters derived from less demanding tasks such as normal gait (Mini-mod) could not verify this benefit.

The advantage of patella resurfacing may be less due to pain relief but due to a functional benefit during demanding motion tasks for which standard clinical scores and low demanding tests do not account for sufficiently and objectively enough. We recommend complementing the classic evaluation tools with demanding functional tests.