Shaving Off Minutes and Complications: The Case for Selective Resurfacing

How a selective patellar retention strategy can significantly improve surgical efficiency, saving an average of 7 minutes per procedure.

While patellar resurfacing during total knee arthroplasty (TKA) remains a hotly debated topic, it continues to be the most popular technique utilized across the United States. However, complications related to costly patellar component revisions persist, driving a steady clinical shift toward leaving the patella unresurfaced during primary TKA. This anatomical retention strategy has historically been criticized due to older studies citing an increased risk of secondary reoperations for anterior knee pain.

Crucially, those historical series utilized older-generation femoral components that lacked modern, “patella-friendly” trochlear geometries. Furthermore, much of the anterior knee pain historically blamed on an unresurfaced patella was likely unrecognized flexion instability—a distinct clinical entity with nearly identical presenting symptoms. We set out to evaluate the true effect of selective patellar resurfacing on validated Patient-Reported Outcome Measures (PROMs) using contemporary, state-of-the-art implant designs.