Hunt, L.P., Matharu, G.S., Blom, A.W. et al. (3 more authors) (2021) Patellar resurfacing during primary total knee replacement is associated with a lower risk of revision surgery. The Bone & Joint Journal, 103-B (5). pp. 864-871. ISSN 2049-4394
Abstract
Aims
Debate remains whether the patella should be resurfaced during total knee replacement (TKR). For non-resurfaced TKRs, we estimated what the revision rate would have been if the patella had been resurfaced, and examined the risk of re-revision following secondary patellar resurfacing.
Methods
A retrospective observational study of the National Joint Registry (NJR) was performed. All primary TKRs for osteoarthritis alone performed between 1 April 2003 and 31 December 2016 were eligible (n = 842,072). Patellar resurfacing during TKR was performed in 36% (n = 305,844). The primary outcome was all-cause revision surgery. Secondary outcomes were the number of excess all-cause revisions associated with using TKRs without (versus with) patellar resurfacing, and the risk of re-revision after secondary patellar resurfacing.
Results
The cumulative risk of all-cause revision at ten years was higher (p < 0.001) in primary TKRs without patellar resurfacing (3.54% (95% confidence interval (CI) 3.47 to 3.62)) compared to those with resurfacing (3.00% (95% CI 2.91 to 3.11)). Using flexible parametric survival modelling, we estimated one ‘excess’ revision per 189 cases performed where the patella was not resurfaced by ten years (equivalent to 2,842 excess revisions in our cohort). The risk of all-cause re-revision following secondary patellar resurfacing was 4.6 times higher than the risk of revision after primary TKR with patellar resurfacing (at five years from secondary patellar resurfacing, 8.8% vs 1.9%).
Conclusion
Performing TKR without patellar resurfacing was associated with an increased risk of revision. Secondary patellar resurfacing led to a high risk of re-revision. This represents a potential substantial healthcare burden that should be considered when forming treatment guidelines and commissioning services.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2021 The British Editorial Society of Bone & Joint Surgery. This is an author-produced version of a paper subsequently published in The Bone & Joint Journal. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Cost; Knee replacement; Outcome; Patella resurfacing; Revision surgery |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Sheffield Teaching Hospitals |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 05 May 2021 09:32 |
Last Modified: | 01 May 2022 00:38 |
Status: | Published |
Publisher: | British Editorial Society of Bone and Joint Surgery |
Refereed: | Yes |
Identification Number: | 10.1302/0301-620X.103B5.BJJ-2020-0598.R2 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:173725 |