Total knee replacement and patellofemoral pain

Background: The decision to resurface the patella or not during total knee replacement (TKR) is a controversial issue. During primary TKR some surgeons routinely resurface the patella, others operate a selective policy and a third group never resurfaces the patella. Aim: This study attempts to investigate the relationship of patellofemoral knee pain and TKR. Materials and Methods: This was a prospective, non-randomised, multi-centre outcome study of 638 primary Insall Burstein II total TKRs, and their effect upon patellofemoral pain. Of those enrolled 378 knees had pre-operative patellofemoral pain; 236 of these underwent patella resurfacing and 142 did not. There were no statistically significant differences in the post-operative incidence of patellofemoral pain between the groups treated with resurfacing of the patella and those in which the patella was left intact. In those knees that developed patellofemoral pain after TKR there was no significant difference as to whether the knee had had resurfacing done or not. Conclusion: Given that the cost of patella resurfacing is not insubstantial and that there are well-known complications resulting from it, we conclude that the role of patellar resurfacing for patellofemoral pain in knee arthritis remains unclear.