Secondary patellar resurfacing after total knee arthroplasty: Functional but not clinical score improvements in a retrospective multicenter study.

Abstract

The role of secondary patellar resurfacing (SPR) in managing persistent anterior knee pain following total knee arthroplasty (TKA) without prior patellar resurfacing remains controversial. While primary patellar resurfacing is routine in some regions, others adopt a selective approach, leading to variability in patient outcomes and management strategies. This retrospective multicenter study analysed patients who underwent SPR after primary TKA between 2012 and 2022. Inclusion criteria encompassed patients with refractory anterior knee pain after an unresurfaced primary TKA, with at least 6 months of follow-up. Pre- and postoperative knee society scores (KSS), range of motion, radiographic parameters and patient satisfaction were assessed. Thirty-four patients (mean age: 69.8 ± 9.3 years, 68% women) met the inclusion criteria. Preoperatively, 94% of patients reported dissatisfaction. Following SPR (<i>n</i> = 30), KSS function improved significantly (70.0 [interquartile range, IQR]: 60.0, 80.0) preoperatively to 80.0 (IQR: 63.8, 100.0; <i>p</i> = 0.03) postoperatively), while KSS Knee did not show a statistically significant change (<i>p</i> = 0.20). Overall, 81% of patients were satisfied or very satisfied postoperatively (<i>p</i> < 0.001). There was no significant association between preoperative patellofemoral osteoarthritis severity and postoperative KSS knee or KSS function. The complication rate requiring reoperation was 10%. SPR may provide meaningful clinical improvements in select patients with persistent anterior knee pain following TKA. A thorough diagnostic workup, including imaging and clinical assessment, is crucial for identifying suitable candidates. Future studies should focus on refining patient selection criteria and standardising indications for SPR. Level IV.