Long-Term Changes of the Nonresurfaced Patella after Total Knee Arthroplasty

Background: The most common complications of total knee arthroplasty involve the patellofemoral joint. However, the long-term fate of the nonresurfaced patella after total knee arthroplasty has seldom been reported. The purpose of this study was to evaluate the long-term changes of the nonresurfaced patella after total knee arthroplasty. Methods: We retrospectively evaluated the nonresurfaced patella in 227 knees (181 patients) at an average of 8.5 years after total knee arthroplasty. Functional results were correlated with radiographic changes, and risk factors leading to abnormal changes of the patella were analyzed. Results: Preoperatively, 186 (82%) of the patellae tracked centrally, thirty-nine (17%) displaced or tilted laterally, and two (1%) subluxated laterally. At the time of the latest follow-up, 133 (59%) of the patellae still tracked centrally with preservation of the cartilage thickness, fifteen (7%) showed early lateral tilt, sixty-eight (30%) had progressive loss of lateral cartilage thickness with lateral tilt and/or displacement, seven (3%) had progressed to lateral subluxation, and four (2%) tilted medially. An abnormal patellofemoral joint did not affect the knee and functional scores (p = 0.90 and 0.89, respectively). However, symptoms such as difficulty rising from a chair or reluctance to use the involved lower limb while climbing stairs were noted. Preoperative patellar maltracking was identified as the only risk factor leading to postoperative patellar abnormalities (relative risk, 2.7; 95% confidence interval, 2.21 to 3.30; p = 0.003). Conclusions: At the time of follow-up, at an average of 8.5 years, patellar tracking and the patellofemoral joint remained normal after approximately 60% of the total knee arthroplasties performed without resurfacing of the patella. Progressive degenerative changes of the nonresurfaced patella (mainly on the lateral facet) and patellar maltracking were the most common abnormal radiographic changes. Patients with preoperative patellar maltracking were at risk for the development of these changes and clinical symptoms. Resurfacing of the patella during total knee arthroplasty may benefit such patients. Level of Evidence: Prognostic study, Level II-1 (retrospective study).