Clinical assessment difference between patellar resurfacing and retention groups with grade IV osteoarthritis in total knee arthroplasty

Introduction. Despite the excellent clinical success with total knee arthroplasty (TKA), there is disagreement about whether or not to replace the patellar articular surface. This led to randomized controlled trials. Such studies are the most reliable source of evidence of the effectiveness of potential interventions. But most of these studies include the study of results at all degrees of osteoarthritis of the patellofemoral joint. Therefore, the authors conducted a prospective study to compare the clinical and radiological outcomes after TKA with the replacement of the patellar articular surface in patients with osteoarthritis of the patellofemoral joint of the fourth degree. Materials and methods. The study included 123 patients with Kellgren-Lawrence patellofemoral joint osteoarthritis. Patients were randomly assigned to groups, in one of which the patellar joint surface was replaced (62 cases), in the other case, they were not performed, i.e. retained the patella (61 cases). Among them were 114 patients who were observed for more than two years (group with replacement of the articular surface - 59 cases, the group without replacement - 55 cases). Preoperative and postoperative clinical data were evaluated and evaluated on the scale of the Hospital for Special Surgery Patellar (HSSP) (total score of 100, presence of pain in the anterior part of the knee, functional limitations, tenderness in palpation or pressure, crepitation , Q-force). Scales developed at the Special Surgery Hospital (HSS), and the WOMAC scale, as well as the volume of movements (ROM), were also used. Results. The mean HSSP score in the group with replacement of the patellar articular surface was 85 points and 83 points in the group without replacement, which showed no significant differences between the groups (p = 0.75). When assessing the presence of pain in the anterior part of the knee, there were also no significant differences between the groups (40 in the group with articular replacement, 36 in the group without replacement, p = 0.52). HSS scores improved to 94 points in the group with articular replacement and up to 95 in the group without replacement, which also indicated no significant difference (p = 0.92). The WOMAC score and the volume of movements were 32 and 128 ° ± 10.5 ° in the replacement group and 29 points and 126 ° ± 11.5 ° - in the group without replacement, there was no significant difference between the groups (p> 05) . The conclusion. Thus, identical good clinical outcomes without significant differences were achieved after TKA with and without replacing the patellar articular surface in patients with a high degree of osteoarthritis of the patellofemoral joint. TKA without replacing the articular patella surface is a good option in patients with a high degree of osteoarthritis of the patellofemoral joint.