Leaving the Patella Unresurfaced in Septic Revision TKA: What the Data Shows

How prioritizing central tracking over patellar resurfacing can mitigate the risk of catastrophic extensor mechanism complications in septic TKA revisions.

Periprosthetic joint infection (PJI) is the most devastating complication following primary total knee arthroplasty (TKA). The therapeutic ‘gold-standard’ for treating chronic PJI is the two-stage revision, which yields durable infection eradication. Two-stage revision involves implant removal, insertion of an antibiotic-loaded cement spacer, and eventual reimplantation with a new prosthesis.

However, deciding whether to resurface the patella during reimplantation remains debated. Proponents of resurfacing cite historical norms, reduced anterior knee pain, and potential cost savings. Opponents point to the risks of catastrophic extensor mechanism complications and argue that leaving the patella unresurfaced yields equivalent patient-reported outcome measures (PROMs). We set out to evaluate whether patellar resurfacing during reimplantation confers a functional benefit or increases implant survivorship after two-stage treatment for PJI.