Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?

Hilal D Maradit Kremers, Omar J. Haque, Walter K Kremers, Daniel J. Berry, David G. Lewallen, Robert T. Trousdale, Rafael J. Sierra

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: To resurface or not to resurface the patella remains a controversy in total knee arthroplasty (TKA). The purpose of this study was to assess the long-term outcomes associated with selectively not resurfacing the patella. Methods: This was a historical cohort study of 15,497 patients with 21,371 primary TKA procedures performed at a single institution between 1985 and 2010. The cohort included 402 (2%) knees with unresurfaced patellae and 20,969 knees with all-polyethylene patellae designs. Reasons for not resurfacing the patella were documented. Multivariable Cox regression analyses were used to estimate the risk of complications and revisions among procedures with unresurfaced patellae. Results: According to the surgeon, reasons for not resurfacing were normal cartilage (226, 56%), young patient (30, 8%), thin patella (53, 13%), and surgeons' choice (93, 23%). In age, sex, and calendar year-adjusted analyses, the risk of complications (hazard ratio [HR]: 1.25, 95% confidence interval [CI]: 1.06, 1.46) and all-cause revisions (HR: 1.39, 95% CI: 1.02, 1.89) were significantly higher after TKA with unresurfaced patellae. However, after adjusting for femoral component types and operative diagnoses, these associations were no longer significant. The only group with significantly worse outcomes were those with a thin patellae with increased risk of complications (HR: 2.66, 95% CI: 1.70, 4.17) and revisions (HR: 5.94, 95% CI: 2.35, 15.02). Yet, the excess risk in the thin patellae group was mainly due to infections, and not related to unresurfaced patellae. Conclusion: Selectively not resurfacing the patella seemed to provide similar results compared with routine resurfacing.

Original languageEnglish (US)
JournalJournal of Arthroplasty
StateAccepted/In press - Jul 19 2016


  • Arthroplasty
  • III
  • Knee
  • Knee revision
  • Patella
  • Resurfacing
  • Retrospective study

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


Dive into the research topics of 'Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?'. Together they form a unique fingerprint.

Cite this