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Patellar resurfacing for total knee replacement: ultimate answer may lie in subgroups: commentary on an article by Suzanne Breeman, PhD, et al.: "Patellar resurfacing in total knee replacement: five-year clinical and economic results of a large randomized controlled trial".

The study by Breeman et al. is an excellent multi-center, randomized, controlled trial initiated in 1999 that enrolled 1715 patients who were randomly allocated to receive or not receive patellar resurfacing during total knee arthroplasty. The authors examined functional knee scores, cost-effectiveness, and the need for subsequent surgery. It is considered to be a Level-I study and is the largest randomized controlled trial of patellar resurfacing to date. Previous studies were either nonrandomized trials or smaller randomized trials1-4, and the existing systematic reviews were based on only a small number of studies with a high level of evidence5,6. Despite everything that has already been stated in the literature regarding patellar resurfacing, the debate continues with no definitive answer. This topic continues to appear on the program at many of the knee arthroplasty meetings, in the form of either a debate or the most recent opinions—which are often contradictory. Thus, although the article by Breeman et al. …