Rethinking Patellar Replacement: Is It Really Necessary?

Patellar resurfacing in total knee arthroplasty (TKA) remains controversial. Recent meta-analyses suggest that patients without resurfaced patellae have greater early revision rates, more anterior knee pain, and lower satisfaction rates. Despite these findings, data from the Swedish Knee Arthroplasty Registry indicate that only 5% of all TKA patients currently receive patellar resurfacing, down from a high of more than 80% in the mid-1980s. This change is likely related to the switch to more anatomical femoral components as well as the realization that the long-term complications of a resurfaced patella are significant and potentially avoidable. In a young TKA patient, the patellar bone stock should be preserved, whereas there is little reason not to resurface in the older population.