The controversy of patellar resurfacing in total knee arthroplasty: Ibisne in medio tutissimus?

Early arthroplasty designs were associated with a high level of anterior knee pain as they failed to cater for the patello-femoral joint. Patellar resurfacing was heralded as the saviour safeguarding patient satisfaction and success but opinion on its necessity has since deeply divided the scientific community and has become synonymous to topics of religion or politics. Opponents of resurfacing contend that the native patella provides better patellar tracking, improved clinical function, and avoids implant-related complications, whilst proponents argue that patients have less pain, are overall more satisfied, and avert the need for secondary resurfacing. The question remains whether complications associated with patellar resurfacing including those arising from future component revision outweigh the somewhat increased incidence of anterior knee pain recorded in unresurfaced patients. The current scientific literature, which is often affected by methodological limitations and observer bias, remains confusing as it provides evidence in support of both sides of the argument, whilst blinded satisfaction studies comparing resurfaced and non-resurfaced knees generally reveal equivalent results. Even national arthroplasty register data show wide variations in the proportion of patellar resurfacing between countries that cannot be explained by cultural differences alone. Advocates who always resurface or never resurface indiscriminately expose the patella to a random choice. Selective resurfacing offers a compromise by providing a decision algorithm based on a propensity for improved clinical success, whilst avoiding potential complications associated with unnecessary resurfacing. Evidence regarding the validity of selection criteria, however, is missing, and the decision when to resurface is often based on intuitive reasoning. Our lack of understanding why, irrespective of pre-operative symptoms and patellar resurfacing, some patients may suffer pain following TKA and others may not have so far stifled our efforts to make the strategy of selective resurfacing succeed. We should hence devote our efforts in defining predictive criteria and indicators that will enable us to reliably identify those individuals who might benefit from a resurfacing procedure. Level of evidence V

Abhandlung der chirurgischen Anatomie und experimentalen Chirurgie.

monografi

Manual de medicina operatoria

Segundo o www Catálogo Colectivo do Patrimonio Bibliografico de Cataluña, a data de esta ed. é ca.1900AntepsContén: Primera parte: Operaciones generales. Segunda parte: Operaciones especiale

Traite d’anatomie chururgicale et de chirurgie experimentale [vol. 2] : Preservation Lab Treatment Report

This item is the second of a 3-volume series received by the lab requiring storage. It is a dark blueish-green leather half binding with a dark blue, grey, tan, and brown marbled paper covering the boards. The textblock features a trimmed edge. The text is in French and is printed in ink on smooth wove paper that is sewn through the fold onto three recessed cords. The leather spine features four false raised bands, with the title of the volume appearing in gold tooling. Part of the leather spine is torn off completely, with the remaining part partially detached along the joints, exposing a strip of tattle tape on top of a green wastepaper spine lining featuring printed English text. The section of the leather spine that is completely torn off is inside the front cover inside a small polyethylene baggie. The inside of the front cover features a Cincinnati Hospital Library bookplate. This item arrived without housing

Manual de medicina operatoria : fundada en la anatomía normal y patológica / por J.F. Malgaine ; traducido de la cuarta y última edición y aumentado con varios procedimientos de autores españoles por Benito Amado Salazar

2 v. ; 19 c

Traite d’anatomie chururgicale et de chirurgie experimentale [vol. 1] : Preservation Lab Treatment Report

This item is the first of a 3-volume series received by the lab requiring storage. It is a dark blueish-green leather half binding with a dark blue, grey, tan, and brown marbled paper covering the boards. The textblock features a trimmed edge. The text is in French and is printed in ink on cream (3), medium (1) thickness smooth wove paper that is sewn through the fold onto three recessed cords. The leather spine is missing, exposing a green wastepaper spine lining featuring printed English text. The inside of the front cover features a Cincinnati Hospital Library bookplate. This item arrived without housing

Manual de medicina operatoria

Introducción fechada en 1882Contiene: vol.I. Operaciones generales (VIII, 700 p.) -- vol.II. Operaciones especiales (XVI, 805 p.

Boletín Oficial de Zamora: Número 150 - 1929 diciembre 16

Copia digital. Madrid : Ministerio de Cultura. Subdirección General de Coordinación Bibliotecaria, 200