Optimizing outcomes in total knee arthroplasty: the role of patellar resurfacing and tibial ınsert type

Abstract

OBJECTIVE: Total knee arthroplasty is a common procedure for advanced knee osteoarthritis, aiming to reduce pain and restore function. However, the impact of patellar resurfacing and tibial insert types (fixed vs. mobile) on clinical outcomes remains debated, with limited comparative studies. METHODS: This retrospective cohort study included total knee arthroplasty patients (2012–2018) with ≥5 years of follow-up, divided into four groups based on insert type and resurfacing status. Clinical outcomes were assessed using visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index, timed up and go, and range of motion. Shapiro-Wilk tests were used to assess normality, and group comparisons were conducted using non-parametric statistical methods. RESULTS: Non-resurfacing groups had significantly higher pain scores (p<0.001). Mobile inserts provided better flexion range of motion and Western Ontario and McMaster Universities Osteoarthritis Index functional scores than fixed inserts (p<0.001). The best functional outcomes were observed in the mobile insert with the resurfacing group. A significant correlation was found between timed up and go and Western Ontario and McMaster Universities Osteoarthritis Index total scores in the fixed insert without resurfacing group (r=0.424, p=0.008), while no such correlation was observed in other groups. CONCLUSION: Patellar resurfacing and mobile tibial inserts enhance pain relief, mobility, and function in total knee arthroplasty patients. However, due to the retrospective nature of the study and group heterogeneity, prospective multicenter trials are warranted to validate these findings. These findings emphasize the importance of individualized implant selection, warranting further prospective, multicenter studies.