García Vélez Dencel A, Buddhiraju Anirudh, Kagan Ryland, Zaniletti Isabella, De Ayushmita, Khanuja Harpal S, Pelt Christopher E, Hegde Vishal
Department of Orthopaedic Surgery, The John Hopkins University, Baltimore, Maryland.
Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon.
J Knee Surg. 2025 Feb;38(3):122-129. doi: 10.1055/a-2468-6289. Epub 2024 Nov 14.
The benefit of patellar resurfacing in total knee arthroplasty (TKA) remains uncertain, with conflicting evidence regarding associated revision rates and clinical outcomes. Although initial studies have reported higher revision rates associated with unresurfaced patellae, recent evidence questions the necessity of routine patellar resurfacing. This study aimed to evaluate the risk of revision following TKA performed with and without patellar resurfacing using data from the American Joint Replacement Registry (AJRR).The AJRR was queried for all patients aged 65 years and older undergoing elective TKA between January 2012 and March 2020 with a minimum 2-year follow-up. Cases were linked using supplemental Centers for Medicare and Medicaid data. Cases with hybrid fixation, highly constrained implants, and revision components were excluded. Patients were categorized into two groups: those with a resurfaced patella and those without. Cumulative incidence function (CIF) curves and cause-specific Cox models were utilized to assess all-cause revision risk, adjusting for sex, age, femoral design (cruciate retaining vs. posterior stabilized), fixation type (cemented vs. cementless), and Charlson Comorbidity Index.Of the 390,304 TKAs with minimum 2-year follow-up in our cohort, 22,829 had no patellar resurfacing performed. Adjusted hazard ratios (HRs) revealed no significant difference in all-cause revision (HR = 0.96, 95% confidence interval [CI]: 0.81-1.13, = 0.656), revision for mechanical loosening (HR = 1.61 [0.88, 2.93], = 0.122), or revision for infection (HR = 1.02 [0.79, 1.33], = 0.860) associated with patellar resurfacing status.Our study found that patients with an unresurfaced patella do not face an increased short-term revision risk following TKA. These findings challenge the necessity of routine patellar resurfacing and underscore the importance of considering other factors, such as femoral design, patient comorbidities, and implant-related variables in revision risk stratification.
全膝关节置换术（TKA）中髌骨表面置换的益处仍不明确，关于相关翻修率和临床结果的证据相互矛盾。尽管最初的研究报告称未进行髌骨表面置换的翻修率较高，但最近的证据对常规髌骨表面置换的必要性提出了质疑。本研究旨在利用美国关节置换登记处（AJRR）的数据，评估进行和未进行髌骨表面置换的TKA术后的翻修风险。
对AJRR进行查询，获取2012年1月至2020年3月期间所有年龄在65岁及以上接受择期TKA且至少随访2年的患者的数据。病例通过补充的医疗保险和医疗补助数据进行关联。排除采用混合固定、高限制性植入物和翻修组件的病例。患者分为两组：进行了髌骨表面置换的患者和未进行髌骨表面置换的患者。采用累积发病率函数（CIF）曲线和病因特异性Cox模型评估全因翻修风险，并对性别、年龄、股骨设计（保留交叉韧带型与后稳定型）、固定类型（骨水泥固定与非骨水泥固定）和Charlson合并症指数进行调整。
在我们队列中，有390,304例TKA至少随访了2年，其中22,829例未进行髌骨表面置换。调整后的风险比（HR）显示，在全因翻修（HR = 0.96，95%置信区间[CI]：0.81 - 1.13，P = 0.656）、因机械性松动翻修（HR = 1.61[0.88, 2.93]，P = 0.122）或因感染翻修（HR = 1.02[0.79, 1.33]，P = 0.860）方面，与髌骨表面置换状态无关。
我们的研究发现，未进行髌骨表面置换的患者在TKA术后不会面临更高的短期翻修风险。这些发现对常规髌骨表面置换的必要性提出了挑战，并强调了在翻修风险分层中考虑其他因素的重要性，如股骨设计、患者合并症和植入物相关变量。
