Patellar resurfacing versus patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses

Alberto Grassi, Riccardo Compagnoni, Paolo Ferrua, Stefano Zaffagnini, Massimo Berruto, Kristian Samuelsson, Eleonor Svantesson, Pietro Randelli

Research output: Contribution to journalReview article

Abstract

PURPOSE: The need of patellar resurfacing in total knee arthroplasty (TKA) is a subject of debate. This systematic review of overlapping meta-analyses aimed to assess and analyze current evidence regarding patellar resurfacing and non-resurfacing in TKA.

METHODS: A systematic literature search was performed in March 2017 in PubMed, CINAHL and Cochrane Library. Inclusion criteria were meta-analysis of randomized controlled trials that compared TKA with and without patellar resurfacing considering as outcomes re-operations rate, complications, anterior knee pain, functional scores. The quality of meta-analyses was evaluated with AMSTAR score and the most relevant meta-analysis was determined by applying the Jadad algorithm.

RESULTS: Ten meta-analyses, published between 2005 and 2015, were included in the systematic review. Two studies found a significantly increased Knee Society Score in the resurfacing group. According to four meta-analyses, anterior knee pain incidence was lower in resurfacing group. Six of the included studies described a greater risk of re-intervention in the non-resurfacing groups. The overall quality of included studies was moderate. The most relevant meta-analysis reported no differences in functional scores and incidence of anterior knee pain between the groups.

CONCLUSIONS: Comparable outcomes were found when comparing patellar resurfacing and non-resurfacing in TKA. The higher risk of re-operations after non-resurfacing should be interpreted with caution due to the methodological limitations of the meta-analyses regarding search criteria, heterogeneity and the inherent bias of easier indication to reoperation when the patella is not resurfaced. There is no clear superiority of patellar resurfacing compared to patellar retention.

LEVEL OF EVIDENCE: Level II, systematic review of meta-analyses.

Original languageEnglish
Pages (from-to)3206-3218
Number of pages13
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume26
Issue number11
DOIs
Publication statusPublished - Nov 2018

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Knee Replacement Arthroplasties
Meta-Analysis
Knee
Pain
Patella
Incidence
Reoperation
PubMed
Libraries
Randomized Controlled Trials

Keywords

  • Arthroplasty
  • Knee
  • Meta-analysis
  • Patella
  • Patellar resurfacing
  • Patellofemoral
  • Replacement
  • Review

Cite this

Patellar resurfacing versus patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses. / Grassi, Alberto; Compagnoni, Riccardo; Ferrua, Paolo; Zaffagnini, Stefano; Berruto, Massimo; Samuelsson, Kristian; Svantesson, Eleonor; Randelli, Pietro.

In: Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 26, No. 11, 11.2018, p. 3206-3218.

Research output: Contribution to journalReview article

Grassi, Alberto ; Compagnoni, Riccardo ; Ferrua, Paolo ; Zaffagnini, Stefano ; Berruto, Massimo ; Samuelsson, Kristian ; Svantesson, Eleonor ; Randelli, Pietro. / Patellar resurfacing versus patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses. In: Knee Surgery, Sports Traumatology, Arthroscopy. 2018 ; Vol. 26, No. 11. pp. 3206-3218.
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abstract = "PURPOSE: The need of patellar resurfacing in total knee arthroplasty (TKA) is a subject of debate. This systematic review of overlapping meta-analyses aimed to assess and analyze current evidence regarding patellar resurfacing and non-resurfacing in TKA.METHODS: A systematic literature search was performed in March 2017 in PubMed, CINAHL and Cochrane Library. Inclusion criteria were meta-analysis of randomized controlled trials that compared TKA with and without patellar resurfacing considering as outcomes re-operations rate, complications, anterior knee pain, functional scores. The quality of meta-analyses was evaluated with AMSTAR score and the most relevant meta-analysis was determined by applying the Jadad algorithm.RESULTS: Ten meta-analyses, published between 2005 and 2015, were included in the systematic review. Two studies found a significantly increased Knee Society Score in the resurfacing group. According to four meta-analyses, anterior knee pain incidence was lower in resurfacing group. Six of the included studies described a greater risk of re-intervention in the non-resurfacing groups. The overall quality of included studies was moderate. The most relevant meta-analysis reported no differences in functional scores and incidence of anterior knee pain between the groups.CONCLUSIONS: Comparable outcomes were found when comparing patellar resurfacing and non-resurfacing in TKA. The higher risk of re-operations after non-resurfacing should be interpreted with caution due to the methodological limitations of the meta-analyses regarding search criteria, heterogeneity and the inherent bias of easier indication to reoperation when the patella is not resurfaced. There is no clear superiority of patellar resurfacing compared to patellar retention.LEVEL OF EVIDENCE: Level II, systematic review of meta-analyses.",
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T1 - Patellar resurfacing versus patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses

AU - Grassi, Alberto

AU - Compagnoni, Riccardo

AU - Ferrua, Paolo

AU - Zaffagnini, Stefano

AU - Berruto, Massimo

AU - Samuelsson, Kristian

AU - Svantesson, Eleonor

AU - Randelli, Pietro

PY - 2018/11

Y1 - 2018/11

N2 - PURPOSE: The need of patellar resurfacing in total knee arthroplasty (TKA) is a subject of debate. This systematic review of overlapping meta-analyses aimed to assess and analyze current evidence regarding patellar resurfacing and non-resurfacing in TKA.METHODS: A systematic literature search was performed in March 2017 in PubMed, CINAHL and Cochrane Library. Inclusion criteria were meta-analysis of randomized controlled trials that compared TKA with and without patellar resurfacing considering as outcomes re-operations rate, complications, anterior knee pain, functional scores. The quality of meta-analyses was evaluated with AMSTAR score and the most relevant meta-analysis was determined by applying the Jadad algorithm.RESULTS: Ten meta-analyses, published between 2005 and 2015, were included in the systematic review. Two studies found a significantly increased Knee Society Score in the resurfacing group. According to four meta-analyses, anterior knee pain incidence was lower in resurfacing group. Six of the included studies described a greater risk of re-intervention in the non-resurfacing groups. The overall quality of included studies was moderate. The most relevant meta-analysis reported no differences in functional scores and incidence of anterior knee pain between the groups.CONCLUSIONS: Comparable outcomes were found when comparing patellar resurfacing and non-resurfacing in TKA. The higher risk of re-operations after non-resurfacing should be interpreted with caution due to the methodological limitations of the meta-analyses regarding search criteria, heterogeneity and the inherent bias of easier indication to reoperation when the patella is not resurfaced. There is no clear superiority of patellar resurfacing compared to patellar retention.LEVEL OF EVIDENCE: Level II, systematic review of meta-analyses.

AB - PURPOSE: The need of patellar resurfacing in total knee arthroplasty (TKA) is a subject of debate. This systematic review of overlapping meta-analyses aimed to assess and analyze current evidence regarding patellar resurfacing and non-resurfacing in TKA.METHODS: A systematic literature search was performed in March 2017 in PubMed, CINAHL and Cochrane Library. Inclusion criteria were meta-analysis of randomized controlled trials that compared TKA with and without patellar resurfacing considering as outcomes re-operations rate, complications, anterior knee pain, functional scores. The quality of meta-analyses was evaluated with AMSTAR score and the most relevant meta-analysis was determined by applying the Jadad algorithm.RESULTS: Ten meta-analyses, published between 2005 and 2015, were included in the systematic review. Two studies found a significantly increased Knee Society Score in the resurfacing group. According to four meta-analyses, anterior knee pain incidence was lower in resurfacing group. Six of the included studies described a greater risk of re-intervention in the non-resurfacing groups. The overall quality of included studies was moderate. The most relevant meta-analysis reported no differences in functional scores and incidence of anterior knee pain between the groups.CONCLUSIONS: Comparable outcomes were found when comparing patellar resurfacing and non-resurfacing in TKA. The higher risk of re-operations after non-resurfacing should be interpreted with caution due to the methodological limitations of the meta-analyses regarding search criteria, heterogeneity and the inherent bias of easier indication to reoperation when the patella is not resurfaced. There is no clear superiority of patellar resurfacing compared to patellar retention.LEVEL OF EVIDENCE: Level II, systematic review of meta-analyses.

KW - Arthroplasty

KW - Knee

KW - Meta-analysis

KW - Patella

KW - Patellar resurfacing

KW - Patellofemoral

KW - Replacement

KW - Review

U2 - 10.1007/s00167-018-4831-8

DO - 10.1007/s00167-018-4831-8

M3 - Review article

C2 - 29335747

VL - 26

SP - 3206

EP - 3218

JO - Knee Surgery, Sports Traumatology, Arthroscopy

JF - Knee Surgery, Sports Traumatology, Arthroscopy

SN - 0942-2056

IS - 11

ER -