Incidence of Anterior Knee Pain Post Total Knee Arthroplasty with Non-Resurfacing of the Patellar: A Descriptive Cross-sectional Retrospective Study

Abstract

Background

Persistent anterior knee pain (AKP) is a complication post-total knee arthroplasty (TKA), primary or revision, due to patellofemoral joint, malalignment, and prosthetic designs. TKA is an intervention for end-stage knee osteoarthritis for pain relief and restoration of function. Several studies advocate non-resurfacing because a native patella enhances kinematics and improves patients’ satisfaction. We aimed to identify the incidence of persistent AKP and quality of life after TKA, 6-month pre- and postoperative.

Methods

A retrospective cohort study by consecutive sampling for 103 patients, with a mean age of 66.65 years, who met the inclusion criteria, gave informed consent, and had undergone TKA with non-resurfacing of the patella between 2019 and 2023 (94 Primary and 9 Revisions) at St. Luke’s Orthopaedic and Trauma Hospital, Kenya. Ethical approval was given by the Institutional Research and Ethics Committee and licensed by the National Commission for Science, Technology and Innovation. Data were collected from surgical registers, medical files, and telephone interviews using the Kujala Score and the 36-item short form survey instrument (SF-36). Study variables were demographic characteristics, functional outcome, and overall patient satisfaction, and were analyzed using descriptive statistics and paired sample t tests for pre- and postoperative scores. McNemar’s test for paired categorical variables. Statistical significance was set to have a P < .05, and effect sizes were calculated with Cohen’s d and phi coefficient (φ).

Results

The Kujala score improved from 36.07 ± 7.19 preoperative to 67.84 ± 3.73 postoperative (t = 39.51, P < .0001). McNemar’s test revealed a highly significant reduction of 84.5% in pain following surgery (χ² = 87, P < .0001) and an incidence of 15.5% (16) of persistent AKP with non-patella resurfacing with the SF-36.

Conclusion

We had improved functional outcomes and quality of life at 6 months after the operation. These findings suggest that routine resurfacing may not be necessary, so a selection approach should be guided by patient characteristics, intraoperative findings, and implant design, especially in resource-limited settings.