To resurface or not? Early pain and functional outcomes following primary total knee arthroplasty

Abstract Introduction: Total knee arthroplasty (TKA) is an effective treatment for advanced knee osteoarthritis; however, the optimal management of the patellofemoral joint remains controversial. While patellar resurfacing may reduce anterior knee pain and reoperation rates, it is also associated with procedure-specific risks. This study compared early postoperative pain and functional outcomes between patellar resurfacing and non-resurfacing with patellar denervation in primary TKA. Materials and Methods: This prospective cohort study ( n = 90) evaluated clinical outcomes following patellar resurfacing compared with non-resurfacing with patellar denervation in patients undergoing primary TKA. The primary outcome was the Knee Society Score (KSS) functional score at 6 months. Secondary outcomes included Visual Analog Scale pain scores and KSS functional sub-scores assessed at 1, 3 and 6 months postoperatively. A post-hoc power analysis demonstrated adequate study power (92%) for the primary outcome. Results: Baseline characteristics were comparable between groups. Resurfacing was associated with lower early pain (1–3 months) and improved 1-month walking and stair function. These differences diminished over time, with no significant intergroup differences in functional scores at 3 or 6 months. No anterior knee pain or patellofemoral complications were observed during follow-up. Conclusion: Patellar resurfacing in primary TKA was associated with early (up to 6-month) improvements in pain relief and functional recovery, with outcomes converging thereafter. These short-term findings support a selective approach to patellar resurfacing based on intraoperative patellofemoral pathology rather than routine resurfacing, pending confirmation from longer-term follow-up.