A prospective randomized clinical trial of patellar resurfacing and nonresurfacing in bilateral TKA

We conducted a randomized clinical trial to determine long-term outcome differences of patella resurfacing versus non-resurfacing in patients undergoing bilateral total knee arthroplasty. We questioned whether there were differences with respect to the operative procedure, anterior knee pain, Knee Society scores, patellofemoral-related revision rates, patient satisfaction and preference, and patellofemoral functional activities. Thirty-two patients (64 knees) underwent primary bilateral single-stage total knee arthroplasty for osteoarthritis. All patients received the same cruciate-retaining total knee arthroplasty. Patients were randomized to resurfacing or nonresurfacing of the patella for the first total knee arthroplasty, and the second knee received the opposite treatment. All living patients were followed to a minimum of 10 years. We found no differences with regard to range of motion, Knee Society Clinical Rating Score, satisfaction, revision rates, or anterior knee pain. Thirty-seven percent of patients preferred the resurfaced knee, 22% the nonresurfaced knee, and 41% had no preference. Two patients (7.4%) in the nonresurfaced group and one patient (3.5%) in the resurfaced group underwent revision for a patellofemoral-related complication. Equivalent clinical results for resurfaced and nonresurfaced patellae in total knee arthroplasty were demonstrated in this 10-year randomized clinical trial. Level of Evidence: Level I, therapeutic study. See the Guide lines for Authors for a complete description of levels of evidence.