The management of the patella in total knee arthroplasty.

Total knee arthroplasty (TKA) is a well-established procedure, and has proven to be durable and effective for the treatment of advanced arthritis of the knee joint. Early TKAs did not include patellar replacement and anterior knee pain was reported after the procedure had been carried out. The incorporation of patellar resurfacing during TKA reduces anterior knee pain, although new complications have emerged. These complications include component failure, instability, fracture, tendon rupture and soft tissue impingement. Such complications are attributed to inferior implant design and improper surgical techniques. Fear of sustaining these complications has prohibited surgeons from routine patellar resurfacing during TKA. Whether or not to resurface the patella during primary TKA is still a controversial topic. There are authors who recommend routine resurfacing, some who do not recommend resurfacing and some who suggest selective resurfacing. The rationale for and against patellar resurfacing during primary TKA has been individually justified and reported in the literature. The selection of suitable implants and adherence to proper surgical technique are the fundamental principles for the success of TKA. Patella resurfacing during TKA is recommended when inflammatory arthritis, an eburnated articular surface and patellofemoral maltracking are present; patella preservation is recommended when there is a small patella, normal articular surface and normal patellar tracking. In long-term follow-up, 60% of nonresurfaced patellas continued to have good tracking after TKA. The correct choice of patellar component size, as well as implant design, medial placement of the patellar component, rule of no thumb and lateral retinaculum release when needed, should be adhered to when performing patellar resurfacing during TKA.