A full knee replacement surgery is a reliable way to relieve pain in the joint regardless of what's causing inflammation, with over 90% of patients reporting a major decrease in the amount of pain they experience on a daily basis. However, there is one particular part of the procedure that is particularly prone to causing complications with the surgery, making it a controversial step for most surgeons. Find out why you need to discuss the pros and cons of patella resurfacing with your doctor before your procedure.

Why are Patellas Resurfaced?

The patella is commonly called the knee cap because it's a piece of bone that sits on the top of the joint and moves over the cartilage of the knee as it flexes. The underside of the patella can become rough and uneven through years of hard use of your knees, resulting in pain as the bone rubs against the nerves in the your joint. When the patella is resurfaced, the surgeon removes some of the bone and the cartilage that is directly below the patella in order to make room for a plastic coating that covers the bottom of the bone.

This smooth plastic surface slides easily over the rest of the knee without causing so much irritation. Without resurfacing, patients are more likely to experience new or continuing anterior knee pain after getting a total knee replacement. This is pain in the front of the knee caused by the rough surface of the unaltered patella.

What Can Go Wrong with Resurfacing?

With such an importance for reducing overall knee pain, you would think that patella resurfacing would be a routine part of every knee replacement. However, many surgeons avoid this part of the surgery unless it's necessary because the patient primarily complains of pain in the patella area. This is due to the potential complications of resurfacing, which include

• Instability in the knee due to the detachment and reattachment of the patella
• Damage or malfunction of the resurfacing cover itself
• Pain and damage to the tendons that hold the patella in place
• Instability and potential fractures in the patella itself due to the thinning necessary before the plastic cover is installed.

All of these problems require a second surgery and further physical therapy to fix, but skipping the resurfacing procedure can also create the need for a second surgery if the patient develops new pain after knee replacement due to the patella. Only an experienced knee surgeon can weigh the benefits and risks to give you a personalized recommendation based on your body and your joint condition.

Who Shouldn't Get Resurfacing?

There are some patients that have a much greater chance of developing complications after getting their patella resurfaced during a total knee replacement surgery. Young people that are not overweight usually face more risks than rewards for patella resurfacing. Your surgeon will also likely skip the resurfacing if

• You've already have a patella fracture and the surgeon can't stabilize it completely
• You rarely use the knee for high demand actions like running or crouching, in which case patella removal is easier
• Your patella has alignment and tracking issues that would be exacerbated by the changes to the bone.

How Can Resurfacing Be Improved?

When resurfacing is necessary or recommended, there are some ways for the surgeon to reduce the chances of complications. First, the surface covering should be made completely from plastic because devices containing metal tend to wear out a lot sooner and cause more pain as they deteriorate. If possible, the surgeon should also avoid putting holes through the patella to anchor the covering and stick to surface grooves that don't weaken the bone as much.

For more information, contact a knee replacement surgeon like Joseph P. Spott, DO.