Patellar resurfacing in primary total knee arthroplasty is associated with fewer reoperations but comparable clinical and functional outcomes: an umbrella review of meta-analyses.

Filippo Migliorini, Nicola Maffulli, Luise Schäfer, Gennaro Pipino, Marcel Betsch, Raju Vaishya

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In one paragraph

Review in Arthroplasty (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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6 authors.

Filippo MiglioriniDepartment of Trauma and Reconstructive Surgery, University Hospital of Halle, Martin-Luther University Halle-Wittenberg, 06097, Halle (Saale), Germany. filippo.migliorini@uk-halle.de.ORCID https://orcid.org/0000-0001-7220-1221

Nicola MaffulliDepartment of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, 00185, Rome, Italy.

Luise SchäferDepartment of Trauma and Reconstructive Surgery, University Hospital of Halle, Martin-Luther University Halle-Wittenberg, 06097, Halle (Saale), Germany.

Gennaro PipinoDepartment of Orthopaedics, Villa Erbosa Hospital, Milan, 40119, Italy.

Marcel BetschDepartment of Orthopaedic, Trauma and Reconstructive Surgery, University Hospital of Erlangen, 91054, Erlangen, Germany.

Raju VaishyaDepartment of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, 110076, India.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatellar management in primary total knee arthroplasty (TKA) remains controversial despite numerous clinical trials and meta-analyses. While patellar resurfacing has been advocated to reduce anterior knee pain (AKP) and reoperation rates, reported effects on functional outcomes are inconsistent. This umbrella review synthesised and critically appraised published meta-analyses comparing patellar resurfacing and patellar retention in primary TKA, with a focus on anterior knee pain, reoperation rates, and patient-reported outcome measures (PROMs).

methodsAn umbrella review of meta-analyses was conducted in accordance with 2020 PRISMA guidelines. Meta-analyses comparing patellar resurfacing with patellar retention in primary TKA were eligible. Outcomes of interest were AKP, reoperation rates, knee range of motion, and PROMs. Quantitative synthesis was performed at the meta-analysis level using random-effects models, with heterogeneity assessed using the I

resultsFourteen meta-analyses published between 2011 and 2025 were included. When AKP was analysed using odds ratios (OR), no significant association with patellar resurfacing was observed (OR 1.13, 95% CI 0.71-1.82; I

conclusionsPatellar resurfacing in primary TKA reduces the risk of reoperation but does not confer clinically meaningful benefits in PROMs and shows only limited and inconsistent effects on AKP.

Indexed as

Anterior knee painClinical heterogeneityEvidence synthesisImplant designPatellofemoral jointPatient selectionRevision surgery

Identifiers

PMID42834409

DOI10.1186/s42836-026-00438-y

PMCPMC13640065

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