ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2023
Total knee arthroplasty without patella resurfacing leads to worse results in patients with patellafemoral osteoarthritis Iwano Stages 3-4: a study based on arthroplasty registry data.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it, 10 citations in OpenAlex.
- [Guideline for the treatment of patellofemoral cartilage defects/arthrosis].Orthopadie (Heidelberg, Germany) · 2025Guideline
- Patellar resurfacing in primary total knee arthroplasty is associated with fewer reoperations but comparable clinical and functional outcomes: an umbrella review of meta-analyses.Arthroplasty (London, England) · 2026Review
- Patellar resurfacing as a prognostic variable in total knee arthroplasty: a two‑decade retrospective cohort (2000‑2020).BMC musculoskeletal disorders · 2026Article
- Preoperative Patellofemoral Malalignment Worsened the Outcome of Patients after Total Knee Arthroplasty.The journal of knee surgery · 2025Observational
- No difference in revision rate in patella-friendly total knee arthroplasty with or without patella resurfacing at 5 years' follow-up. A database analysis.Journal of experimental orthopaedics · 2025Article
- [Knee arthroplasty in isolated patellofemoral osteoarthritis : A critical review of the best options].Orthopadie (Heidelberg, Germany) · 2025Review
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Authors and funding
11 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo determine whether the preoperative degree of degeneration of the patellofemoral joint really affects the outcome of total knee arthroplasty (TKA) surgery without patella resurfacing and thus to establish a parameter that might serve as a guiding factor to decide whether or not to perform retropatellar resurfacing. It was hypothesized that patients with preoperative mild patellofemoral osteoarthritis (Iwano Stages 0-2) would significantly differ from patients with preoperative severe patellofemoral osteoarthritis (Iwano Stages 3-4) in terms of patient-reported outcome (Hypothesis 1) and revision rates/survival (Hypothesis 2) after TKA without patella resurfacing.
methodsApplication of a retrospective-comparative design on the basis of Arthroplasty Registry data that included patients with primary TKA without patella resurfacing. Patients were allocated to the following groups based on preoperative radiographic stage of patellofemoral joint degeneration: (a) mild patellofemoral osteoarthritis (Iwano Stage ≤ 2) and (b) severe patellofemoral osteoarthritis (Iwano Stages 3-4). The Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) score was assessed preoperative and 1 year postoperative (0: best, 100 worst). In addition, implant survival was calculated from the Arthroplasty Registry data.
resultsIn 1209 primary TKA without patella resurfacing, postoperative WOMAC total and WOMAC subscores did not differ significantly between groups, but potentially suffered from type 2 error. Three-year survival was 97.4% and 92.5% in patients with preoperative mild and severe patellofemoral osteoarthritis, respectively (p = 0.002). Five-year survival was 95.8% vs. 91.4% (p = 0.033) and 10-year survival was 93.3% vs. 88.6% (p = 0.033), respectively.
conclusionsFrom the study findings, it is concluded that patients with preoperative severe patellofemoral osteoarthritis have significantly higher risks for reoperation than do those with preoperative mild patellofemoral osteoarthritis-when treated with TKA without patella resurfacing. Hence, it is recommended that patella resurfacing be applied in patients with severe Iwano Stage 3 or 4 patellofemoral osteoarthritis during TKA. LEVEL OF EVIDENCE: III, Retrospective comparative.
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