Wiberg Type III patellae and J-sign during extension compromise outcomes of total knee arthroplasty without patellar resurfacing

Knee. 2020 Jun;27(3):787-794. doi: 10.1016/j.knee.2020.04.005. Epub 2020 Jun 3.


Background: Understanding the risk factors associated with postoperative pain and worse outcome can guide surgeons on whether primary patellar resurfacing is warranted during total knee arthroplasty (TKA). The purpose of this study was to determine whether clinical scores and pain after TKA without patellar resurfacing are correlated with patellar shape and postoperative patellar position and kinematics.

Methods: Radiographs as well as anterior knee pain according to the Visual Analogue Scale (pVAS) were collected pre- and postoperatively for 100 knees aged 68 ± 7.7 years that received uncemented TKA without patellar resurfacing. At a minimum follow-up of 12 months the Forgotten Joint Score (FJS), the Oxford Knee Score (OKS) as well as the flexion range of motion and the presence of J-sign during active extension were recorded. Uni- and multivariable linear regression analyses were performed to determine associations between the collected clinical scores and patient demographic and radiographic data.

Results: Postoperative OKS (79 ± 14.4) was worse for Wiberg Type III patellae (β = -11.4, P = .020, compared with Type II). Anterior pVAS (2 ± 2) was greater in knees with J-sign during extension (β = 2.8, P < .001). None of the other radiographic measurements (patellar tilt, congruence angle and lateral patellar displacement) were correlated with postoperative OKS or anterior pVAS.

Conclusion: Incongruent patellar shape (Wiberg Type III) is associated with worse clinical scores, and abnormal kinematics (J-sign) with increased pain after TKA without patellar resurfacing. The authors therefore recommend routine resurfacing for Wiberg Type III patellae, though further studies are required to confirm whether resurfacing truly improves clinical scores and pain in this subgroup.

Keywords: Anterior knee pain; Patellar resurfacing; Patellar shape; TKA; Unresurfaced patella.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Female
  • Humans
  • Knee Prosthesis
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / diagnostic imaging
  • Osteoarthritis, Knee / surgery*
  • Pain, Postoperative / diagnostic imaging
  • Pain, Postoperative / epidemiology*
  • Patella / diagnostic imaging
  • Patella / surgery*
  • Radiography
  • Range of Motion, Articular
  • Retrospective Studies
  • Treatment Outcome
  • Visual Analog Scale