Debate: Resurfacing Patella in Full Knee Arthroplasty
For those of us not well acquainted with the annual American Association of Orthopedic Surgeons (AAOS) conference, we may not know what exactly the buzz is, or where possible factions lie. On March 1-6, the AAOS met in conference to discuss the latest, and perhaps controversial, topics in orthopedic surgery.
Total Knee Arthroplasty
This year’s “most debated” topic revolves around total knee arthroplasty. The debated project is not about the procedure, but about part of the procedure: whether or not to resurface the knee. Ok, so this is the hot topic for orthopedics. But what does it mean to those who suffer from chronic knee pain and may be considering a total knee arthroplasty?
Perhaps it’s best to define what a total knee arthroplasty is. According to Medical New Today (MNT), total knee arthroplasty is, “‘knee resurfacing.” The procedure entails restoring the weight bearing facade of the knee joint that is damaged, worn out, or diseased, to relieve pain and movement disability. It is performed through the implant of an orthopedic metal and plastic component shaped as a joint so that the knee can move properly.”
Interesting that the definition, as put forth by MNT, includes resurfacing. Yet, there is a divide in how this procedure is done “across the pond,” or rather, between Europe and America. In Orthopedics Today, Jay Lieberman, M.D., chair of the Department of Orthopaedic Surgery at the Keck School of Medicine of USC and outgoing president of the American Academy of Hip and Knee Surgeons, states, “One of the biggest issues in the total joint replacement is whether or not to resurface the patella. Generally speaking, in the U.S., the majority of the patellas are resurfaced; in Europe it is the opposite.”
A few camps surround this issue. Some consider resurfacing the patella to be simply what’s done: others who simply do not perform it: and finally, those who make surgical decisions on the process based on the age and thickness of the patella itself. Those are enough camps to make a lively debate.
The issue is pain. Does resurfacing the patella eventually give the patients less pain than before? That evidence is also up for debate. MNT goes on to state, “Although randomized controlled trials (RCTs) indicate that the results are equivalent between those resurfaced and those not, 10% of patients who do not undergo resurfacing have some type of pain and may require revision. However, just resurfacing the patella may not eliminate the pain. Patients with a resurfaced patella may also complain of pain. Some patients have mild anterior knee pain going up and down stairs, something that may occur because the person’s quadriceps and hamstrings are not strong enough.”
The above quote sounds inconclusive at best. To break it down: if you are experiencing chronic knee pain, and are about to undergo total knee arthroplasty, what will be the best option for you?
Research is still underway regarding this particular procedure. The good news, however, is that orthopedic surgeons actually have these type of conferences. It’s the critical and scientific debates that help further the practice of medicine. Especially when the conference is global, and when global techniques vary, the doctors can then compare the evidence, in order to make the best choices for their patients.
To learn more about other topics being discussed in this year’s conference, visit their website. After all, it’s issues like these that affect us most of all: the patients.
- What Is Knee Replacement Surgery? What Is Knee Arthroplasty?, (Medical News Today), September 16, 2014, http://www.medicalnewstoday.com/articles/247500.php.
- ‘General Topics Feature’, February 26, 2016, accessed February 26, 2016, https://ryortho.com/2016/02/1-debated-issue-in-tka-is-freeze-nerves-before-tka-improve-outcomes-and-more/.
- ‘Arthroplasty’, accessed February 26, 2016, http://medical-dictionary.thefreedictionary.com/arthroplasty.
- ‘Annual Meeting’, accessed February 27, 2016, http://www.aaos.org/Annual_Meeting/Annual_Meeting_Home/Annual_Meeting/?ssopc=1.
- Matthew P. Abdel, Sébastien Parratte, and Nicolaas C. Budhiparama, The Patella in Total Knee Arthroplasty: To Resurface or Not Is the Question, 7, no. 2 (April 5, 2014), accessed February 26, 2016, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4092199/.