JOA - 2026-05-05 - Journal Article
Is Inflammatory Arthritis an Absolute Indication for Patellar Resurfacing in Total Knee Arthroplasty?
Song BM, Ford CA, Schneider AM, Nunley RM, Barrack RL, Bendich I
Topics
Key Takeaway
TKA without patellar resurfacing in inflammatory arthritis produced no difference in reoperation (5.7% vs 3.7%), revision (0.6% vs 0.6%), or anterior knee pain (4.9% vs 7.8%) compared to OA, while the resurfaced IA group had significantly higher aseptic reoperation (13.2% vs 3.4%, p=0.02) and revision rates (13.2% vs 0.6%, p<0.01).
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Summary
This study asked whether inflammatory arthritis mandates patellar resurfacing in primary TKA by comparing matched IA and OA cohorts without resurfacing, and a secondary IA with-versus-without resurfacing comparison. Among unresurfaced knees, IA and OA showed no significant differences in reoperation, revision, patella-related complications, or anterior knee pain at mean 24 months. The resurfaced IA group had markedly higher aseptic reoperation (13.2% vs 3.4%, p=0.02) and revision rates (13.2% vs 0.6%, p<0.01) without any reduction in anterior knee pain or patella-related complications.
Key Limitation
The IA-PR cohort (n=38) is too small and likely represents a selected high-risk group, making the with-versus-without PR comparison within IA unreliable and potentially misleading.
Original Abstract
BACKGROUND
Inflammatory arthritis (IA) has been considered an absolute indication for patellar resurfacing (PR) in total knee arthroplasty (TKA), yet limited contemporary data exists to support this. The purpose of this study was 1) to compare outcomes of TKA without PR for IA and osteoarthritis (OA) and 2) to compare outcomes of TKA for IA with and without PR.
METHODS
A retrospective review of all primary TKAs at an academic institution between March 2017 to May 2024 was performed. We identified 348 TKAs without PR performed for IA. This cohort was matched by demographics to 348 TKAs without PR performed for OA. A secondary comparison of 38 TKAs for IA with PR (IA-PR) during the same period was performed. Outcomes included reoperation, revision, patella-related complications, and presence of anterior knee pain (AKP). The mean follow-up was 24 months. T-tests and Fisher's exact tests were performed.
RESULTS
Among TKA without PR, 20 (5.7%) IA and 13 (3.7%) OA underwent reoperation (P = 0.28); two (0.6%) in each group underwent revision (P = 1.0). There were no differences in aseptic (3.4 IA versus 2.6% OA; P = 0.66), patella-related (1.4 IA versus 0.9% OA, P = 0.73), or septic (2.3 IA versus 1.1% OA; P = 0.38) reoperations. There were four (1.1%) IA versus zero OA TKAs underwent secondary PR (P = 0.12). Among TKA without PR, there was no difference in AKP between IA (4.9%) and OA (7.8%) (P = 0.16). Among TKA for IA with and without PR, there was no difference in AKP (4.9 IA versus 5.3% IA-PR; P = 0.58). The PR group had more aseptic reoperations (3.4 IA versus 13.2% IA-PR; P = 0.02) and revisions (0.6 IA versus 13.2% IA-PR; P < 0.01), but similar patella-related complications (1.4 IA versus 2.6% IA-PR, P = 0.47).
CONCLUSION
In TKA without PR for IA compared to OA, there were no differences in reoperations, revisions, patella-related complications, or AKP. Additionally, PR did not improve outcomes in IA.