Patellar resurfacing in knee arthroplasty: A comprehensive review and meta-analysis

BACKGROUND Patellar resurfacing in knee arthroplasty remains a contentious issue, with various strategies including routine, selective, and non-resurfacing approaches. This review and meta-analysis aim to assess the incidence of patellar resurfacing, revision rates, patient satisfaction, and relevant knee scores associated with each method. AIM To determine the comparative effectiveness of routine, selective, and non-resurfacing strategies in patellar resurfacing within knee arthroplasty by evaluating incidence rates, revision rates, patient satisfaction, and knee function scores. METHODS A systematic review spanning from 1990 to 2024 was conducted using PubMed, Embase, and Cochrane Library databases. Studies reporting on the incidence of patellar resurfacing, revision rates, patient satisfaction, and relevant knee scores were included. Data from esteemed world registries such as the Australian Orthopaedic Association National Joint Replacement Registry, the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man and Danish Knee Arthroplasty Registry among others, were meticulously examined. Meta-analysis was employed to derive pooled estimates and 95% confidence intervals. RESULTS Analysis of data sourced from diverse world registries and literature sources unveiled significant disparities in the incidence of patellar resurfacing across different geographic regions and healthcare institutions. For instance, the incidence of routine patellar resurfacing ranged from 60% to 90% in some regions, while in others, it was as low as 30% to 50%. The meta-analysis indicated that routine resurfacing was associated with a lower revision rate of 3.5% (95%CI: 2.8%-4.2%) compared to non-resurfacing approaches, which exhibited a higher revision rate of 6.8% (95%CI: 5.5%-8.1%). Patient satisfaction outcomes showed variability, with routine resurfacing demonstrating higher mean satisfaction scores in functionality, pain relief, and stability categories. CONCLUSION The findings underscore the complexity of patellar resurfacing in knee arthroplasty and highlight the need for continued research to refine clinical practice. Future studies should prioritize prospective randomized controlled trials comparing different patellar resurfacing techniques using standardized outcome measures. Longitudinal studies with extended follow-up periods are necessary to evaluate the long-term outcomes and durability of various patellar resurfacing strategies. Collaborative efforts among multidisciplinary teams will be essential to conduct high-quality research that can provide actionable insights and improve patient outcomes.