Non-resurfacing techniques in the management of the patella at total knee arthroplasty: A systematic review and meta-analysis

• A systematic review of 12 studies and a meta-analysis of eight of these studies
• We analysed techniques of non-resurfacing intervention during total knee arthroplasty.
• Osteophyte excision only or with denervation, debridement and micro-fracture was analysed.
• No significant difference in the mean change of the Knee Society Score between these techniques

BackgroundRecent meta-analyses support not resurfacing the patella at the time of TKA. Several different modes of intervention are reported for non-resurfacing management of the patella at TKA.MethodsWe have conducted a systematic review and meta-analysis of non-resurfacing interventions in TKA. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study methodology and reporting system was adopted, utilising the PRISMA checklist and statement.Classes of patella interventions were defined as:0.No intervention.1.Osteophyte excision only.2.Osteophyte excision, denervation, with soft tissue debridement.3.Osteophyte excision, denervation, soft tissue debridement, and drilling or micro-fracture of eburnated bone.4.Patellar resurfacing.A meta-analysis was conducted upon the pre- and post-operative KSS for each technique.ResultsFour hundred and twenty-three studies were identified, 12 studies met the inclusion criteria for the systematic review and eight for the meta-analysis. Two studies compared different non-resurfacing patellar techniques, the other studies used the non-resurfacing cohort as controls for their prospective RCTs comparing patellar resurfacing with non-resurfacing. The meta-analysis revealed no significant difference between the techniques.ConclusionsWe conclude that there is no significant difference in KSS for differing non-resurfacing patellar techniques, but further trials using patellofemoral specific scores may better demonstrate superior efficacy of specific classes of patella intervention, by virtue of greater sensitivity for patellofemoral pain and dysfunction.Level of evidenceI