International Orthopaedics

, Volume 43, Issue 3, pp 611–617 | Cite as

Predictors for secondary patellar resurfacing after primary total knee arthroplasty using a “patella-friendly” total knee arthroplasty system

  • Philip P. RoesslerEmail author
  • Randa Moussa
  • Cornelius Jacobs
  • Karl F. Schüttler
  • Thomas Stein
  • Frank A. Schildberg
  • Dieter C. Wirtz
Original Paper



Patellar resurfacing (PR) in total knee arthroplasty (TKA) is still one of the major controversies in orthopaedic surgery today. The aim of the present retrospective case-control study was to identify predictors for secondary patellar resurfacing (SPR) after initial TKA to create a rationale for surgeons to decide which patients to resurface primarily. It was hypothesized that proper TKA implantation and component positioning as well as a maintained physiological patellar geometry will lead to a reduced risk of SPR. Overmore, it was hypothesized that intrinsic factors like overweight might also have an influence on the need for SPR.


After identification of suitable patients and age/sex matching in a 1:2 fashion, 29 cases (TKA/SPR) and 58 controls (TKA) were included and screened for available clinical and epidemiological data as well as for radiographic data after primary TKA. Pearson’s correlation analysis as well as logistic regression modeling was performed to identify possible predictors for SPR following TKA.


Binary logistic regression was able to correctly classify 88.5% of patients into case or control groups. It indicated that patella tilt, patella height, and thickness as well as the delta angle were significant predictors of a need for SPR following primary TKA. An increase in patellar width by 1 mm will increase the risk of SPR, while an increase in patellar thickness by 1 mm will reduce it. An increase in patellar tilt by 1° will also increase the risk of SPR. Finally, an increase in delta angle by 1° will again reduce the risk of SPR.


Easy and accessible radiographic measurements have been identified as possible predictors of SPR following primary TKA. Although indication for primary PR may still remain a controversial topic, a rationale has been proposed in this study to support surgeons in objectively estimating an individual patient’s risk for SPR prior to primary TKA measuring the patella tilt, width, and thickness. Overmore, regarding surgical aspects of TKA, tibial component positioning has also been shown to be of importance to reduce the risk of SPR.


Total knee arthroplasty Patellar resurfacing Patellofemoral pain Predictors 



The authors wish to thank Johannes Wagenhaeuser, MD, for his kind support in obtaining the radiographic datasets.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. Additional approval for this study was obtained from the institutional review board of our hospital (study no. 224/17).


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopaedics and Trauma SurgeryUniversity Hospital BonnBonnGermany
  2. 2.Center for Orthopedics and TraumatologyUniversity Hospital Giessen & MarburgMarburgGermany
  3. 3.Department of Sporttraumatology - Knee- and Shoulder-SurgeryBerufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurtGermany

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