KAT patellar resurfacing

Patellar resurfacing in total knee replacement: five-year clinical and economic results of a large randomized controlled trial.

Breeman S, Campbell M, Dakin H, et al. The Journal of bone and joint surgery. American volume 2011 · PMID 22204002 · doi:10.2106/jbjs.j.00725

Question

Should the patella be routinely resurfaced during total knee replacement?

Design

Multicentre UK RCT nested within the Knee Arthroplasty Trial (KAT) with 5-year clinical and cost-effectiveness analysis.

Patients

Patients undergoing primary total knee replacement for arthritis in UK centres.

Intervention

Patellar resurfacing

Comparison

No patellar resurfacing

Primary outcome

Oxford Knee Score at 5 years

Key result

There was no significant difference in Oxford Knee Score or any other outcome at 5 years, including reoperation and later patella-related surgery, and total healthcare costs did not differ between resurfacing and non-resurfacing.

Limitations

Multiple implant designs and surgeon preferences were included; the trial was not powered for small differences in reoperation.

Impact on practice

Shows that routine patellar resurfacing gives no meaningful functional benefit, so the choice remains surgeon- and implant-dependent; UK practice has remained split, unlike the routine resurfacing seen in the USA.