Patellar Resurfacing In Total Knee Arthroplasty-a Systematic Review And Meta-analysis

Objective: To evaluate the efficacy of patellar resurfacing or non-resurfacing intotal knee arthroplasty systematically, so as to provide reference for further clinicalresearch and medical practice. Methods: Comprehensive retrieval and access all ofthe literatures of randomized controlled trials comparing total knee arthroplastyperformed with and without patellar resurfacing from2001to2013published bothhome and abroad. According to the inclusion and exclusion criteria, and detected theliteratures met evaluation criteria, evaluation of the literature in bias riskassessment, quality, and extracted the research data. Meta analysis was performedwith RevMan5.2software. Results: There are a total of13published trials whichmeet the test requirements consisted of1736knees underwent total knee arthroplasty.Of while855knees in the resurfaced group,881knees in the non-resurfaced group.Meta-analysis showed that:(1)Whether using subgroup analysis by follow-up time orusing overall analysis revealed no statistically difference in patient satisfactionbetween the resurfaced group and non-resurfaced group, the combined RR for theoverall analysis was0.78,95%CI（0.51-1.20）.(2) The risk of re-operation was lowerin patellar resurfacing group than in patellar non-resurfacing group, the combined RRwas0.50，95%CI(0.33-0.78). According to follow-up time for subgroup analysis: therisk of re-operation was lower in patellar resurfacing group than in patellarnon-resurfacing group5years after surgery, the combined RR was0.31，95%CI(0.16-0.58);but there was no significant difference between the two groups lessthan5years after surgery, the combined RR was0.92,95%CI(0.49-1.73).(3)Bothusing subgroup analysis by follow-up time and using overall analysis, there was nostatistically difference regarding patient satisfaction between two groups, thecombined RR for the overall analysis was1.17,95%CI(0.80-1.73). Also there was nostatistically difference in the mean postoperative knee society clinical scores between two groups, the combined MD for the overall analysis was0.40，95%C（I-0.94,1.73）.Conclusion: Patellar resurfacing can reduce the risk of re-operation5years later aftertotal knee arthroplasty, but there was no difference in the risk of postoperative anteriorknee pain、patient satisfaction and postoperative knee society clinical scores. Due tothe existence of bias in varying degrees in the literature, the results should beinterpreted with caution, the conclusion still need rigorously designed, largesample, multi-center and long-term follow-up randomized controlled trials to confirmfurther.