Impact of Patellar Thickness in Total Knee Arthroplasty: Clinical and Functional Outcomes and early Complications
Article Sidebar
Published:
Oct 27, 2025
Keywords:
Total knee arthroplasty, knee replacement, patellofemoral joint, patellar thickness
Main Article Content
Abstract
Introduction: Total knee arthroplasty (TKA) is effective in restoring function in patients with knee osteoarthritis. Restoration of the native patellar thickness is a critical aspect, but there is no consensus regarding the optimal thickness. The aim of this study was to evaluate the impact of patellar thickness on clinical and functional outcomes, radiological findings, complications, and revision rates in patients undergoing primary TKA.
Materials and Methods: We conducted a retrospective study of patients who under- went TKA for primary osteoarthritis, with patellar resurfacing, and a minimum follow-up of 24 months. Recorded data included age, sex, body mass index, alignment, preoperative and postoperative patellar thickness, anterior knee pain, Knee Society Score (KSS), Visual Analog Scale (VAS) for pain, complication rates, and revision rates.
Results: The series included 44 patients (mean age, 70.4 ± 10.8 years), all treated with the same prosthesis model. KSS, VAS, and anterior knee pain scores improved signifi- cantly. No significant differences were found between preoperative and postoperative patellar thickness (22.6 ± 2.9 mm vs. 22.0 ± 1.5 mm; p = 0.09). Postoperatively, 15.9% of patients had the same thickness as before surgery, while differences of 1 mm, 2 mm, and 3 mm were observed in 45.5%, 29.5%, and 9.1% of patients, respectively.
Conclusion: Patellar thickness did not significantly influence clinical or functional scores, complication rates, or revision rates following primary TKA.
Materials and Methods: We conducted a retrospective study of patients who under- went TKA for primary osteoarthritis, with patellar resurfacing, and a minimum follow-up of 24 months. Recorded data included age, sex, body mass index, alignment, preoperative and postoperative patellar thickness, anterior knee pain, Knee Society Score (KSS), Visual Analog Scale (VAS) for pain, complication rates, and revision rates.
Results: The series included 44 patients (mean age, 70.4 ± 10.8 years), all treated with the same prosthesis model. KSS, VAS, and anterior knee pain scores improved signifi- cantly. No significant differences were found between preoperative and postoperative patellar thickness (22.6 ± 2.9 mm vs. 22.0 ± 1.5 mm; p = 0.09). Postoperatively, 15.9% of patients had the same thickness as before surgery, while differences of 1 mm, 2 mm, and 3 mm were observed in 45.5%, 29.5%, and 9.1% of patients, respectively.
Conclusion: Patellar thickness did not significantly influence clinical or functional scores, complication rates, or revision rates following primary TKA.
Downloads
Download data is not yet available.
Article Details
How to Cite
Pérez Alamino, L., Oláran, M. A., Garabano, G., & Pesciallo, C. Ángel. (2025). Impact of Patellar Thickness in Total Knee Arthroplasty: Clinical and Functional Outcomes and early Complications. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(5), 431-437. https://doi.org/10.15417/issn.1852-7434.2025.90.5.2150
Section
Clinical Research
Copyright (c) 2025 Revista de la Asociación Argentina de Ortopedia y Traumatología
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
References
1. Pérez Alamino L, Garabano G, Pesciallo CÁ, Del Sel H. Bilateral simultaneous total knee arthroplasty with and without patellar resurfacing. A prospective single surgeon series with a minimum follow-up of 7 years. Knee Surg Relat Res 202429;36(1):21. https://doi.org/10.1186/s43019-024-00225-6
2. Chua HS, Whitehouse SL, Lorimer M, De Steiger R, Guo L, Crawford RW. Mortality and implant survival with simultaneous and staged bilateral total knee arthroplasty: experience from the Australian Orthopaedic Association National Joint Replacement Registry. J Arthroplasty 2018;33(10):3167-73. https://doi.org/10.1016/j.arth.2018.05.019
3. Tanikawa H, Tada M, Ogawa R, Harato K, Niki Y, Kobayashi S, et al. Influence of patella thickness on patellofemoral pressure in total knee arthroplasty. BMC Musculoskelet Disord 2021;22(1):298. https://doi.org/10.1186/s12891-021-04175-y
4. Tammachote N, Kraisin T, Kanitnate S. Do we need to restore patellar thickness after total knee arthroplasty with patellar resurfacing? Eur J Orthop Surg Traumatol 2023;33(8):3677-82. https://doi.org/10.1007/s00590-023-03607-w
5. Dhollander AAM, Bassens D, Victor J, Verdonk P. Patellar tilt and thickness do not influence postoperative flexion in a high-flex design total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013;21(12):2817-22. https://doi.org/10.1007/s00167-012-2245-6
6. Burgos-Vargas R, Cardiel MH, Loyola-Sánchez A, de Abreu MM, Pons-Estel BA, Rossignol M, et al. Characterization of knee osteoarthritis in Latin America. A comparative analysis of clinical and health care utilization in Argentina, Brazil, and Mexico. Reumatol Clin 2014;10(3):152-9. https://doi.org/10.1016/j.reuma.2013.07.013
7. Figueroa D, Figueroa F, Calvo R, Vaisman A, Figueroa M, Putnis S. Trends in total knee arthroplasty in a developing region: A survey of Latin American orthopaedic surgeons. J Am Acad Orthop Surg 2020;28(5):189-93. https://doi.org/10.5435/JAAOS-D-19-00260
8. Breugem SJ, Haverkamp D. Anterior knee pain after a total knee arthroplasty: what can cause this pain? World J Orthop 2014;5(3):163-70. https://doi.org/10.5312/wjo.v5.i3.163
9. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain 1997;72(1-2):95-7. https://doi.org/10.1016/s0304-3959(97)00005-5
10. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989;(248):13-4. PMID: 2805470
11. Saad A, Nischal N, Sharma A, Agrawal Y, Iyengar KP, Botchu R. The linear coronal knee offset (LCKO)- preliminary study of new method of measuring knee varus/valgus malalignment. Indian J Radiol Imaging 2023;33(4):484-8. https://doi.org/10.1055/s-0043-1770085
12. Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. [Patella infera. Apropos of 128 cases]. Rev Chir Orthop Reparatrice Appar Mot 1982;68(5):317-25. [En francés] PMID: 6216535
13. Bonifacio JP, Costa Paz M, Yacuzzi CH, Carbo L. Rango de movilidad y resultados funcionales en tres diseños diferentes de artroplastia de rodilla primaria. Estudio comparativo. Rev Asoc Argent Ortop Traumatol 2016;81(4):264-73. https://doi.org/10.15417/596
14. Bartolomeo C, Vanoli F, Iglesias S, Pioli I, Allende BL. Evaluación del Knee Society Score en sus tipos convencional y versión modificada en el reemplazo total de rodilla con el mismo modelo de prótesis. Rev ACARO 2019;2(5):41-6. Disponible en: https://acaro.org.ar/acarorevista/images/revistas/05_02/AC_0043_OR.pdf
15. Torres G. Estudio métrico morfológico de la rodilla: diferencias sexuales en una colección esquelética contemporánea Tesis doctoral. Escuela Nacional de Antropología e Historia. México. 2002. Disponible en: https://www.academia.edu/23619667/
16. Hernández-Vaquero D. La alineación de la artroplastia de rodilla. Antiguos mitos y nuevas controversias. Rev Esp Cir Ortop Traumatol 2021;65(5):386-97. https://doi.org/10.1016/j.recot.2021.01.002
17. Gracia-Ochoa M, Miranda I, Orenga S, Hurtado-Oliver V, Sendra F, Roselló-Añón A. Peri-prosthetic femoral fractures of hip or knee arthroplasty. Analysis of 34 cases and a review of Spanish series in the last 20 years. Rev Esp Cir Ortop Traumatol 2016;60(5):271-8. https://doi.org/10.1016/j.recot.2016.06.005
18. Anchuela Ocaña J, Gómez Pellico L, Ferrer Blanco M, Rodríguez Torres R, Slocker de Arce AM. Sustitución rotuliana en la artroplastia de rodilla. Análisis biomecánico comparativo. Rev Ortop Traumatol 1999;43(3):201-6.
19. Pierson JL, Ritter MA, Keating EM, Faris PM, Meding JB, Berend ME, et al. The effect of stuffing the patelofemoral compartment on the outcome of total knee arthroplasty. J Bone Joint Surg Am 2007;89(10):2195-
203. https://doi.org/10.2106/JBJS.E.01223
20. Lee QJ, Yeung ST, Wong YC, Wai YL. Effect of patellar thickness on early results of total knee replacement with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2014;22(12):3093-9. https://doi.org/10.1007/s00167-014-3235-7
21. Sánchez-Márquez JM, Rodríguez-Merchán EC. Implantación del componente rotuliano en la artroplastia total de rodilla: situación actual. Rev Esp Cir Ortop Traumatol 2010;54(3):186-92. https://doi.org/10.1016/j.recot.2010.01.005
22. Yosum YS, Cho WS, Woo JH, Kim BK. The effect of patellar thickness changes on patellar tilt in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2010;18(7):923-7. https://doi.org/10.1007/s00167-010-1059-7
2. Chua HS, Whitehouse SL, Lorimer M, De Steiger R, Guo L, Crawford RW. Mortality and implant survival with simultaneous and staged bilateral total knee arthroplasty: experience from the Australian Orthopaedic Association National Joint Replacement Registry. J Arthroplasty 2018;33(10):3167-73. https://doi.org/10.1016/j.arth.2018.05.019
3. Tanikawa H, Tada M, Ogawa R, Harato K, Niki Y, Kobayashi S, et al. Influence of patella thickness on patellofemoral pressure in total knee arthroplasty. BMC Musculoskelet Disord 2021;22(1):298. https://doi.org/10.1186/s12891-021-04175-y
4. Tammachote N, Kraisin T, Kanitnate S. Do we need to restore patellar thickness after total knee arthroplasty with patellar resurfacing? Eur J Orthop Surg Traumatol 2023;33(8):3677-82. https://doi.org/10.1007/s00590-023-03607-w
5. Dhollander AAM, Bassens D, Victor J, Verdonk P. Patellar tilt and thickness do not influence postoperative flexion in a high-flex design total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013;21(12):2817-22. https://doi.org/10.1007/s00167-012-2245-6
6. Burgos-Vargas R, Cardiel MH, Loyola-Sánchez A, de Abreu MM, Pons-Estel BA, Rossignol M, et al. Characterization of knee osteoarthritis in Latin America. A comparative analysis of clinical and health care utilization in Argentina, Brazil, and Mexico. Reumatol Clin 2014;10(3):152-9. https://doi.org/10.1016/j.reuma.2013.07.013
7. Figueroa D, Figueroa F, Calvo R, Vaisman A, Figueroa M, Putnis S. Trends in total knee arthroplasty in a developing region: A survey of Latin American orthopaedic surgeons. J Am Acad Orthop Surg 2020;28(5):189-93. https://doi.org/10.5435/JAAOS-D-19-00260
8. Breugem SJ, Haverkamp D. Anterior knee pain after a total knee arthroplasty: what can cause this pain? World J Orthop 2014;5(3):163-70. https://doi.org/10.5312/wjo.v5.i3.163
9. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain 1997;72(1-2):95-7. https://doi.org/10.1016/s0304-3959(97)00005-5
10. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989;(248):13-4. PMID: 2805470
11. Saad A, Nischal N, Sharma A, Agrawal Y, Iyengar KP, Botchu R. The linear coronal knee offset (LCKO)- preliminary study of new method of measuring knee varus/valgus malalignment. Indian J Radiol Imaging 2023;33(4):484-8. https://doi.org/10.1055/s-0043-1770085
12. Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. [Patella infera. Apropos of 128 cases]. Rev Chir Orthop Reparatrice Appar Mot 1982;68(5):317-25. [En francés] PMID: 6216535
13. Bonifacio JP, Costa Paz M, Yacuzzi CH, Carbo L. Rango de movilidad y resultados funcionales en tres diseños diferentes de artroplastia de rodilla primaria. Estudio comparativo. Rev Asoc Argent Ortop Traumatol 2016;81(4):264-73. https://doi.org/10.15417/596
14. Bartolomeo C, Vanoli F, Iglesias S, Pioli I, Allende BL. Evaluación del Knee Society Score en sus tipos convencional y versión modificada en el reemplazo total de rodilla con el mismo modelo de prótesis. Rev ACARO 2019;2(5):41-6. Disponible en: https://acaro.org.ar/acarorevista/images/revistas/05_02/AC_0043_OR.pdf
15. Torres G. Estudio métrico morfológico de la rodilla: diferencias sexuales en una colección esquelética contemporánea Tesis doctoral. Escuela Nacional de Antropología e Historia. México. 2002. Disponible en: https://www.academia.edu/23619667/
16. Hernández-Vaquero D. La alineación de la artroplastia de rodilla. Antiguos mitos y nuevas controversias. Rev Esp Cir Ortop Traumatol 2021;65(5):386-97. https://doi.org/10.1016/j.recot.2021.01.002
17. Gracia-Ochoa M, Miranda I, Orenga S, Hurtado-Oliver V, Sendra F, Roselló-Añón A. Peri-prosthetic femoral fractures of hip or knee arthroplasty. Analysis of 34 cases and a review of Spanish series in the last 20 years. Rev Esp Cir Ortop Traumatol 2016;60(5):271-8. https://doi.org/10.1016/j.recot.2016.06.005
18. Anchuela Ocaña J, Gómez Pellico L, Ferrer Blanco M, Rodríguez Torres R, Slocker de Arce AM. Sustitución rotuliana en la artroplastia de rodilla. Análisis biomecánico comparativo. Rev Ortop Traumatol 1999;43(3):201-6.
19. Pierson JL, Ritter MA, Keating EM, Faris PM, Meding JB, Berend ME, et al. The effect of stuffing the patelofemoral compartment on the outcome of total knee arthroplasty. J Bone Joint Surg Am 2007;89(10):2195-
203. https://doi.org/10.2106/JBJS.E.01223
20. Lee QJ, Yeung ST, Wong YC, Wai YL. Effect of patellar thickness on early results of total knee replacement with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2014;22(12):3093-9. https://doi.org/10.1007/s00167-014-3235-7
21. Sánchez-Márquez JM, Rodríguez-Merchán EC. Implantación del componente rotuliano en la artroplastia total de rodilla: situación actual. Rev Esp Cir Ortop Traumatol 2010;54(3):186-92. https://doi.org/10.1016/j.recot.2010.01.005
22. Yosum YS, Cho WS, Woo JH, Kim BK. The effect of patellar thickness changes on patellar tilt in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2010;18(7):923-7. https://doi.org/10.1007/s00167-010-1059-7