J Korean Orthop Assoc.  2023 Aug;58(4):348-354. 10.4055/jkoa.2023.58.4.348 .

Total Knee Arthroplasty with Patellar Retention in Patients with Rheumatoid Arthritis: Comparative Study between Patellar Resurfacing and Retention

• Chung SH
• Kim HJ
• Kyung HS
• Lee HJ
• Shin JY
• Choi CB

• KMID: 2545295
• DOI: http://doi.org/10.4055/jkoa.2023.58.4.348

Abstract

Purpose
To evaluate functional and radiographic results of the total knee arthroplasties (TKA) with the non-resurfaced patella in patients with rheumatoid arthritis.
Materials and Methods
From 1994 to 2020, 65 patients (91 knees) with rheumatoid arthritis who had TKA without patellar resurfacing were followed up retrospectively. Eleven male and eighty female cases were included; the mean age and follow-up period were 61.5 years and 71 months, respectively. Preoperative and postoperative range of motion (ROM), Hospital for Special Surgery (HSS) score, Knee Society Knee Score (KS), Function Score (FS) and modified patellar score for clinical assessment and the presence of anterior knee pain and complications were compared. Radiographs were used for patellofemoral tracking by patellar skyline view.
Results
In patients with patellar resurfacing, the average age was 67.3 years and the average follow-up period was 68.1 months. In patients with patellar retention, the average age was 59.6 years and the average follow-up period was 72.4 months. After surgery, in patients with patellar resurfacing, the ROM was improved significantly from 105° to 119°. The HSS, KS, FS, and modified patella scores improved from 59.3 to 84.7, 56.0 to 90.9, 50.7 to 70.2, and 15.1 to 22.8. In patients in whom the patella was preserved, the ROM also increased significantly from 100° to 116°. The HSS, KS, FS, and modified patellar scores improved from 55.3 to 83.7, 50.2 to 89.9, 46.1 to 69.3, and 15.6 to 22.0, respectively. The postoperative results were similar in the two groups. After surgery, the number of patients showing anterior knee pain decreased from 21 to 0 and 62 to 3, respectively, and there was no significant difference between the two groups. There was no significant difference in patellofemoral tracking on radiographs and complications between the two groups.
Conclusion
By retaining the native patella, satisfactory postoperative clinical and radiologic results could be obtained after total knee arthroplasty in patients with rheumatoid arthritis. TKA without patellar resurfacing is suitable for the rheumatoid arthritis group.

Keyword

total knee arthroplasty; rheumatoid arthritis; patella