Retropatellar resurfacing in primary total knee arthroplasty does not improve clinical outcomes but increases revision rates

Controversy still remains regarding the necessity of primary retropatellar resurfacing (RPR) in total knee arthroplasty (TKA). While some studies suggest retropatellar resurfacing reduces anterior knee pain (AKP) and revision rates, others report no significant differences compared to non-resurfaced TKA. This study aims to evaluate postoperative complications, pain levels, and functional outcomes in patients undergoing TKA with and without RPR. A retrospective, single-center observational study was conducted including 121 patients who underwent primary TKA. Fifty-five patients (45.5%) had RPR, while 66 patients (54.5%) retained their native patella. Clinical outcomes were assessed using the knee society score (KSS), while radiological parameters such as femoral and patellar offset were analyzed. Statistical comparisons were performed using independent t-tests and chi-square tests, with significance set at p < 0.05. Radiological analysis revealed a significant reduction in femoral offset postoperatively (p < 0.001), with greater changes observed in the non-RPR group (p = 0.009). Patellar offset was also significantly reduced in non-RPR patients compared to RPR patients (p < 0.001). The revision rate was higher in the RPR group (10 cases) compared to the non-RPR group (1 case). Functional assessment using the KSS showed no significant differences in knee pain (p = 0.418) or knee scores (p = 0.461) between groups. However, patients in the RPR group were more likely to require walking aids postoperatively (p = 0.012). RPR in primary TKA did not result in superior pain relief or functional outcomes compared to non-resurfacing but was associated with a higher revision rate and increased postoperative use of walking aids. These findings suggest that the decision to resurface should be individualized based on clinical and anatomical considerations. Level III (Retrospective Cohort).