JOA - 2026-04-21 - Journal Article
Does Patellar Resurfacing Impact Patient-Perceived Outcomes Following Primary Total Knee Arthroplasty? A Propensity-Matched Analysis.
Freeman I, Shimizu M, Ilyas MH, Sampson WT, Mannina C, Kwon YM
Topics
Key Takeaway
In 1,764 propensity-matched primary TKA patients, patellar resurfacing produced no clinically meaningful difference in PROMs or complication rates compared to non-resurfacing, with only one isolated KOOS-PS score favoring the non-resurfaced group (73.2 vs 71.2, p=0.03).
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study asked whether patellar resurfacing affects PROMs or complication rates in primary TKA using a propensity-matched institutional database of 5,197 consecutive patients. After 1:2 matching on age, BMI, sex, race, comorbidities, and implant type, absolute scores, delta scores, MCID-based proportions of improvement, and complication rates were compared across multiple PROMs. No clinically meaningful differences were found between groups; the single statistically significant PROM difference (KOOS-PS 73.2 vs 71.2) favored non-resurfacing but did not meet clinical significance thresholds.
Key Limitation
Absence of reported follow-up duration and lack of anterior knee pain-specific outcome measures (e.g., Kujala score) limits conclusions about the primary theoretical benefit of resurfacing.
Original Abstract
BACKGROUND
Patellar resurfacing is performed in up to 87% of total knee arthroplasties (TKA) in the United States. While reducing anterior knee pain is a theoretical benefit, there are no established best practices for resurfacing in primary TKA. Previous studies comparing resurfacing-related patient-reported outcome measures (PROMs) were limited by sample size and a lack of propensity-matching. This study aimed to compare the impact of patellar resurfacing on complication rates and clinically meaningful PROMs in propensity-matched primary TKA patients using an institutional database.
METHODS
A total of 5,197 consecutive patients who underwent TKA were categorized based on patellar resurfacing. A 1:2 match by age, body mass index, sex, race, comorbidities, and implants was conducted. Commonly used PROMs were extracted. The mean PROM scores were recorded for each cohort. Differences between the mean pre- and postoperative scores (delta scores) were calculated. The distribution-based minimal clinically important difference values were computed. Postoperative complication rates and proportions of clinical improvement, no change, and worsening were recorded. Of the eligible patients, 1,176 resurfaced patients were matched to 588 non-resurfaced patients. There were no demographic differences between matched groups (P > 0.05).
RESULTS
Preoperative Patient-Reported Outcomes Measurement Information System Global Health Physical (42.6 versus 41.8, P = 0.0414) and postoperative Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (73.2 versus 71.2, P = 0.0299) was significantly higher in the non-resurfaced group. All other absolute scores, delta scores, and proportions of clinically meaningful improvement were similar across PROMs (P > 0.05). Complication rates were also comparable between groups (P > 0.05).
CONCLUSION
This is one of the first studies to compare clinically meaningful PROMs in propensity-matched patellar resurfaced and non-resurfaced TKA patients. There were no differences in complication rates or PROMs, which suggests that patients achieve similar outcomes with modern implants regardless of patellar resurfacing.