,15 Rae et al ,16 Harwin et al 17 and Larson et al 18 using vario

,15 Rae et al.,16 Harwin et al.17 and Larson et al.18 using various types of prostheses advocated routine selleck chemical Trichostatin A patellar replacement based on 10 years of excellent clinical results and low morbidity attributable to patellar replacement. A definite conclusion cannot be drawn from these different studies. Randomized studies represent the best design to compare patellar resurfacing and non-resurfacing. However different outcomes and variable conclusions were reported by the investigators. From a general point of view, the systematic review allows integration of existing information and provides data for a rational decision making. Moreover, it increases the statistical power of the study and can establish whether findings are consistent and can be generalized across population, local and treatment variations.

The explicit method used in systematic reviews limits bias and improves reliability and accuracy of the conclusions when quality criteria are fulfilled.19,20 The meta-analysis of patellar resurfacing was performed by Nizard et al.21 in 12 randomized, controlled trials between January 1966 and August 2003. The resurfaced patella had better performance and we found higher relative risk of re-operation due to significant anterior knee pain and significant pain when climbing stairs where the patella was left non-resurfaced. No differences were observed between the two groups regarding the functional score of the International Knee Society, the score of the Hospital for Special Surgery and patient satisfaction. Parvizi et al.22 performed a meta-analysis of 14 studies between 1966 and 2003.

The incidence of anterior knee pain was higher when the patellae were not resurfaced. Secondary resurfacings due to anterior knee pain were required in 8.7% of the non-resurfaced knees. There were no differences in reported complications. Total knee arthroplasty resulted in improved functional outcome regardless of patellar resurfacing. Although there is controversy, the scientific evidence that favors patellar resurfacing in primary total knee arthroplasty (TKA) is abundant. The literature shows a substantially higher incidence of anterior knee pain and higher rates of re-operation where the patella is not resurfaced primarily. Prospective randomized studies have reported re-operation rates to carry out the resurfacing of the patella that exceeded the complications after the surgery with resurfacing.

23,24 When resurfacing the patella, strict surgical principles are paramount to avoid complications. These principles include doubling the original thickness of the patella, maintenance of patellar blood supply, achieving central patellar tracking and properly positioning of the femoral, tibial and patellar components. The ideal characteristics of the design of the prosthesis to the resurfacing of the patella are anatomical, Anacetrapib asymmetric and wide trochlear groove, that extends and deepens more compared with the first-generation designs.

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