JOA - 2026-06-01 - Journal Article; Randomized Controlled Trial; Comparative Study
A Prospective, Single-Center, Randomized Controlled Study Comparing Non-Resurfacing versus Resurfacing in a Cohort of 250 Posterior-Stabilized Total Knee Arthroplasty With a Minimum Five-Year Follow-Up.
Catteeuw A, Vermue H, Lefeuvre A, Servien E, Batailler C, Lustig S
Topics
Key Takeaway
In 213 knees randomized to patellar resurfacing (PR) versus non-resurfacing (PNR) with a patella-friendly PS-TKA, 5-year implant survival was equivalent (93.6% vs 91.8%, P=0.96) with no significant difference in any clinical outcome score.
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Summary
This single-center RCT randomized 250 primary PS-TKA knees to PR or PNR using the same patella-friendly implant, asking whether routine resurfacing improves clinical or radiographic outcomes at 5 years. No significant between-group differences were found in KSS knee (P=0.10), KSS function (P=0.19), Forgotten Joint Score (P=0.24), Kujala (P=0.36), or Lille anterior knee pain scores (P=0.43). Secondary PR was required in 4.5% of PNR knees versus patellar button revision in 1.8% of PR knees, with no significant difference in patellofemoral revision rate (3.8% overall, P=0.16).
Key Limitation
Single-center design with a single implant system means findings may not generalize to CR implants or designs without patella-friendly trochlear geometry, where the resurfacing debate may yield different results.
Original Abstract
BACKGROUND
Despite extensive research, patellar management during total knee arthroplasty (TKA) remains controversial. We therefore asked the following: Is there a difference in clinical and radiological outcomes at a minimum 5-year follow-up with a modern posterior-stabilized TKA performed with or without patellar resurfacing (PR)?
MATERIALS AND METHODS
This single-center prospective randomized trial included 250 knees (245 patients) undergoing primary TKA between April 2017 and November 2018. Exclusion criteria were isolated patellofemoral osteoarthritis, constrained TKA, and preoperative flexion less than 90°. Patients were randomized into PR or patellar nonresurfacing (PNR) groups, receiving the same posterior-stabilized "patella-friendly" prosthesis. Clinical evaluation at 5-year follow-up included the Knee Society Score (KSS), Forgotten Joint Score, Kujala and Lille scores for anterior knee pain, and range of motion. Radiographic assessment evaluated patellofemoral osteoarthritis progression and patellar implant loosening. Complications and surgical revisions were recorded.
RESULTS
There were 213 knees (109 in PR, 104 in PNR) available with a 5-year follow-up (9% lost to follow-up and 4% deceased). Clinical outcomes showed no significant differences between groups (KSS knee: P = 0.10; KSS function: P = 0.19; Forgotten Joint Score: P = 0.24; Kujala: P = 0.36; Lille: P = 0.43). There were five patients (4.5%) in PNR who required secondary PR, whereas two patients (1.8%) in PR required revision of the patellar button. The revision rate for patellofemoral causes was 3.8%, without significant difference between groups (P = 0.16). At 60 months, implant survival was similar between PR and PNR (93.6 and 91.8%; P = 0.96).
CONCLUSION
This large prospective randomized study found no clinical advantage of routine PR at 5-year follow-up. While resurfacing may reduce anterior knee pain, it also introduces risks such as fracture and maltracking. In the context of patella-friendly posterior-stabilized implants, these findings support a more selective approach, which should be guided by objective criteria.