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Patellar dislocation
4%
161/3990
Anterior knee pain
81%
3235/3990
Extensor tendon rupture
145/3990
Decreased quadriceps strength
2%
81/3990
Patellar clunk syndrome
9%
343/3990
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Patients with rheumatoid arthritis who undergo a total knee arthroplasty without patellar resurfacing are more likely to have anterior knee pain when compared to the same patient population with resurfaced patellas. Resurfacing the patella during total knee arthroplasty is a topic of controversy. Those against resurfacing note minimal issues with patellar tilt and overstuffing the patellofemoral joint. Supporters of resurfacing state that the patellofemoral joint will eventually become arthritic if not resurfaced, and that the rate of anterior knee pain is much higher. Multiple studies, however, have shown superior results in patients with rheumatoid arthritis that have had their patella resurfaced. Burnett et al. review the indications for patellar resurfacing during total knee arthroplasty. They consider not resurfacing the patella in patients less than 60 with non-inflammatory arthritis and a maintained patellofemoral joint space. Holt et al. also review the role of patellar resurfacing. They mention that patellar resurfacing should be routinely done in patients with rheumatoid arthritis, preoperative patellofemoral pain, height greater than 160cm, weight greater than 60kg, or advanced patellar changes either pre- or intra-operatively. Illustration A shows plain anteroposterior (a) and lateral (b) radiographs of the knee in a patient with rheumatoid arthritis. Degenerative changes are present in all 3 joint compartments. There is collapse of the lateral compartment with resultant valgus deformity. Erosion of the anterior aspect of the distal femoral metaphysis due to pannus is also seen. Incorrect Answers: Answer 1: Patellar dislocation has not been found to be higher in patellas that are not resurfaced. Answer 3: Extensor tendon rupture is more common in patients that have had their patella resurfaced. Answer 4: Multiple studies have not shown a difference in quadriceps strength with or without resurfacing. Answer 5: Patellar clunk syndrome is more common in patients who have had their patella resurfaced.
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