{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T03:25:05Z","timestamp":1781839505716,"version":"3.54.5"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009411","name":"Universit\u00e9 Paris-Est Cr\u00e9teil","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009411","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["International Orthopaedics (SICOT)"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Regarding patellar resurfacing in total knee arthroplasty (TKA), no consensus has been reached, but most studies have not addressed specific pathological circumstances. Evidence on the roles of patellar resurfacing and synovectomy in managing postoperative effusion in patients with severe chondrocalcinosis is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>\n                      This single-centre observational cohort study included 160 patients who underwent the same TKA for osteoarthritis with severe chondrocalcinosis (grade 4) between January 2000 and December 2010. A matched design created four comparable groups of 40 patients each: (1) TKA without patellar resurfacing or synovectomy, (2) TKA with patellar resurfacing alone, (3) TKA with synovectomy alone, and (4) TKA with both patellar resurfacing and synovectomy. Severe chondrocalcinosis (advanced calcium pyrophosphate deposition disease) was confirmed through radiographic findings, synovial fluid analysis using polarized light microscopy, and histology. Significant postoperative effusion was diagnosed with ultrasound, quantified by sterile joint aspiration, and classified as stage I (10\u201320 cm\n                      <jats:sup>3<\/jats:sup>\n                      ), stage II (21\u201330 cm\n                      <jats:sup>3<\/jats:sup>\n                      ), or stage III (&gt;\u200930 cm\n                      <jats:sup>3<\/jats:sup>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Postoperative joint effusion varied significantly between the strategies. In the patellar resurfacing group, 25% (10\/40) of patients developed only stage I effusion without synovectomy. Conversely, 45% (18\/40) of patients in the synovectomy-only group developed stage II effusion, while 62.5% (25\/40) of patients without either procedure developed stage III effusion (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). TKA with both patella resurfacing and synovectomy resulted in either stage I (7\/40) or stage II effusion (6\/40). Multivariate regression confirmed patellar resurfacing as an independent protective factor against postoperative effusion (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Average aspirated effusion volumes further supported these findings: 39\u2009\u00b1\u20096 cm\n                      <jats:sup>3<\/jats:sup>\n                      for TKA without additional procedures, 18\u2009\u00b1\u20098 cm\n                      <jats:sup>3<\/jats:sup>\n                      with synovectomy, 6\u2009\u00b1\u20094 cm\n                      <jats:sup>3<\/jats:sup>\n                      with patellar resurfacing, and 7\u2009\u00b1\u20094 cm\n                      <jats:sup>3<\/jats:sup>\n                      with both patellar resurfacing and synovectomy. The results showed that as total knee effusion volume increased, inflammatory markers (C-reactive protein level) increased, and range of motion decreased.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In severe chondrocalcinosis, patellar resurfacing may be appropriate to prevent joint effusion after TKA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00264-026-06767-6","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T21:57:13Z","timestamp":1772575033000},"page":"1009-1019","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Patellar resurfacing is associated with reduced postoperative effusion compared with synovectomy in severe chondrocalcinosis undergoing total knee arthroplasty"],"prefix":"10.1007","volume":"50","author":[{"given":"Philippe","family":"Hernigou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nizar","family":"Touati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles-Henri","family":"Flouzat-Lachaniette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"issue":"4","key":"6767_CR1","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1177\/15563316231183971","volume":"20","author":"RW Lutz","year":"2024","unstructured":"Lutz RW, Post ZD, Thalody HS, Czymek MM, Ponzio DY, Kim CE, Ong AC (2024) Genicular artery embolization: a promising treatment option for recurrent effusion following total knee arthroplasty. HSS J 20(4):508\u2013514. https:\/\/doi.org\/10.1177\/15563316231183971","journal-title":"HSS J"},{"key":"6767_CR2","first-page":"1241","volume":"16","author":"DT Felson","year":"1989","unstructured":"Felson DT, Anderson JJ, Naimark A, Kannel W, Meenan RF (1989) The prevalence of chondrocalcinosis in the elderly and its association with knee osteoarthritis: the Framingham study. J Rheumatol 16:1241\u20131245","journal-title":"J Rheumatol"},{"key":"6767_CR3","first-page":"570","volume":"29","author":"BA Derfus","year":"2002","unstructured":"Derfus BA, Kurian JB, Butler JJ (2002) The high prevalence of pathologic calcium crystals in preoperative knees. J Rheumatol 29:570\u2013574","journal-title":"J Rheumatol"},{"key":"6767_CR4","doi-asserted-by":"publisher","first-page":"e59","DOI":"10.1016\/j.ocl.2012.07.009","volume":"43","author":"GS Levi","year":"2012","unstructured":"Levi GS, Sadr K, Scuderi GR (2012) Bilateral pseudogout 8 years after bilateral total knee arthroplasty. Orthop Clin North Am 43:e59-62","journal-title":"Orthop Clin North Am"},{"key":"6767_CR5","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/j.arth.2004.11.022","volume":"22","author":"CB Hirose","year":"2007","unstructured":"Hirose CB, Wright RW (2007) Calcium pyrophosphate dehydrate deposition disease (pseudogout) after total knee arthroplasty. J Arthroplasty 22:273\u2013276","journal-title":"J Arthroplasty"},{"key":"6767_CR6","doi-asserted-by":"publisher","first-page":"1322","DOI":"10.1136\/bmj.331.7528.1322","volume":"331","author":"G Holt","year":"2005","unstructured":"Holt G, Vass C, Kumar CS (2005) Acute crystal arthritis mimicking infection after total knee arthroplasty. BMJ 331:1322\u20131323","journal-title":"BMJ"},{"key":"6767_CR7","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1007\/s00167-010-1270-6","volume":"19","author":"K Kilicarslan","year":"2011","unstructured":"Kilicarslan K, Yalcin N, Cicek H, Dogramaci Y, Ugurlu M, Ozkan H, Yildirim H (2011) The effect of total synovectomy in total knee arthroplasty: a prospective randomized controlled study. Knee Surg Sports Traumatol Arthrosc 19:932\u2013935","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"3","key":"6767_CR8","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1007\/s00167-021-06519-6","volume":"30","author":"CS Moret","year":"2022","unstructured":"Moret CS, Iordache E, D\u2019Ambrosi R, Hirschmann MT (2022) Chondrocalcinosis does not affect functional outcome and prosthesis survival in patients after total or unicompartmental knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 30(3):1039\u20131049","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"6767_CR9","doi-asserted-by":"publisher","unstructured":"Ross BJ, Arellano E, McCall M, Manz W, Armstrong C, Khan I, Debbi EM, Dickenson E, Evans J, Wilson JM, Premkumar A (2025) Do implant-specific associations exist between patellar resurfacing and all-cause revision risk after primary total knee arthroplasty? A retrospective analysis of two national joint registries. J Arthroplasty S0883\u20135403(25)01441-X. https:\/\/doi.org\/10.1016\/j.arth.2025.11.016. Online ahead of print.","DOI":"10.1016\/j.arth.2025.11.016"},{"issue":"4","key":"6767_CR10","doi-asserted-by":"publisher","DOI":"10.1002\/jeo2.70501","volume":"12","author":"H Vermue","year":"2025","unstructured":"Vermue H, Debette C, Metrop M, Lyoussi S, Batailler C, Servien E, LySKS (Lyon School of Knee Surgery) (2025) Secondary patellar resurfacing after total knee arthroplasty: functional but not clinical score improvements in a retrospective multicenter study. J Exp Orthop 12(4):e70501. https:\/\/doi.org\/10.1002\/jeo2.70501","journal-title":"J Exp Orthop"},{"key":"6767_CR11","unstructured":"Rosenthal AK, Ryan LM (2005) Calcium pyrophosphate crystal deposition disease, pseudogout and articular chondrocalcinosis. In: Koopman WJ, Moreland LW (eds) Arthritis and Allied Conditions. Lippincott Williams and Wilkins, Philadelphia, pp 2373\u20132396"},{"key":"6767_CR12","unstructured":"Rosenthal AK, Ryan LM (2003) Pathogenesis of osteoarthritis: crystals and osteoarthritis. In: Brandt KD, Doherty M, Lohmander LS (eds) Osteoarthritis. Oxford University Press, New York, pp 120\u2013124"},{"key":"6767_CR13","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.rdc.2006.02.004","volume":"32","author":"AK Rosenthal","year":"2006","unstructured":"Rosenthal AK (2006) Calcium crystal deposition and osteoarthritis. Rheum Dis Clin North Am 32:401\u2013412","journal-title":"Rheum Dis Clin North Am"},{"issue":"4","key":"6767_CR14","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1136\/ard.16.4.494","volume":"16","author":"J Kellgren","year":"1957","unstructured":"Kellgren J, Lawrence J (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494","journal-title":"Ann Rheum Dis"},{"issue":"5","key":"6767_CR15","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1002\/acr.21598","volume":"64","author":"P Mandl","year":"2012","unstructured":"Mandl P, Brossard M, Aegerter P et al (2012) Ultrasound evaluation of fluid in knee recesses at varying degrees of flexion. Arthritis Care Res (Hoboken) 64(5):773\u2013779. https:\/\/doi.org\/10.1002\/acr.21598","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"6767_CR16","doi-asserted-by":"publisher","first-page":"309","DOI":"10.2106\/00004623-196648020-00009","volume":"48","author":"DJ McCarty","year":"1966","unstructured":"McCarty DJ, Hogan JM, Gatter RA (1966) Studies on pathological calcifications in human cartilage. J Bone Joint Surg 48:309\u2013325","journal-title":"J Bone Joint Surg"},{"issue":"2","key":"6767_CR17","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/0968-0160(95)00013-F","volume":"2","author":"DA Woods","year":"1995","unstructured":"Woods DA, Wallace DA, Woods CG, McLardy-Smith P, Carr AJ, Murray DW, Martin J, Gunther T (1995) Chondrocalcinosis and medial unicompartmental knee arthroplasty. Knee 2(2):117-l19","journal-title":"Knee"},{"issue":"5","key":"6767_CR18","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1302\/0301-620X.93B5.26214","volume":"93","author":"H Pandit","year":"2011","unstructured":"Pandit H, Jenkins C, Gill HS, Smith G, Price AJ, Dodd CAF, Murray DW (2011) Unnecessary contraindications for mobile-bearing unicompartmental knee replacement. J Bone Joint Surg Br 93(5):622\u2013628","journal-title":"J Bone Joint Surg Br"},{"key":"6767_CR19","doi-asserted-by":"publisher","first-page":"1973","DOI":"10.1007\/s11999-011-2211-5","volume":"470","author":"P Hernigou","year":"2012","unstructured":"Hernigou P, Pascale W, Pascale V, Homma Y, Poignard A (2012) Does primary or secondary chondrocalcinosis influence long-term survivorship of unicompartmental arthroplasty? Clin Orthop Relat Res 470:1973\u20131979","journal-title":"Clin Orthop Relat Res"},{"key":"6767_CR20","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s12306-015-0394-8","volume":"100","author":"H Pandit","year":"2016","unstructured":"Pandit H, Spiegelberg B, Clav\u00e9 A, McGrath C, Liddle AD, Murray DW (2016) Aetiology of lateral progression of arthritis following Oxford medial unicompartmental knee replacement: a case\u2013control study. Musculoskelet Surg 100:97\u2013102","journal-title":"Musculoskelet Surg"},{"issue":"6","key":"6767_CR21","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.1016\/j.arth.2016.12.036","volume":"32","author":"TW Hamilton","year":"2017","unstructured":"Hamilton TW, Pandit HG, Jenkins C, Mellon SJ, Dodd CAF, Murray DW (2017) Evidence-based indications for mobile-bearing unicompartmental knee arthroplasty in a consecutive cohort of thousand knees. J Arthroplasty 32(6):1779\u20131785","journal-title":"J Arthroplasty"},{"issue":"1","key":"6767_CR22","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1007\/s00167-015-3578-8","volume":"25","author":"V Kumar","year":"2017","unstructured":"Kumar V, Pandit HG, Liddle AD, Borror W, Jenkins C, Mellon SJ, Hamilton TW, Athanasou N, Dodd CAF, Murray DW (2017) Comparison of outcomes after UKA in patients with and without chondrocalcinosis: a matched cohort study. Knee Surg Sports Traumatol Arthrosc 25(1):319\u2013324","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"5","key":"6767_CR23","doi-asserted-by":"publisher","first-page":"1512","DOI":"10.1007\/s11999-013-3447-z","volume":"472","author":"G-C Lee","year":"2014","unstructured":"Lee G-C, Lotke PA (2014) Does chondrocalcinosis affect knee society scores and range of motion after TKA? Clin Orthop Relat Res 472(5):1512\u20131517","journal-title":"Clin Orthop Relat Res"},{"issue":"9","key":"6767_CR24","doi-asserted-by":"publisher","first-page":"2970","DOI":"10.1007\/s00167-019-05725-7","volume":"28","author":"JH Willems","year":"2019","unstructured":"Willems JH, Rassir R, Sierevelt IN, Nolte PA (2019) There is no difference in postoperative pain, function and complications in patients with chondrocalcinosis in the outcome of total knee arthroplasty for end-stage osteoarthritis. Knee Surg Sports Traumatol Arthrosc 28(9):2970\u20132979. https:\/\/doi.org\/10.1007\/s00167-019-05725-7","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"12","key":"6767_CR25","doi-asserted-by":"publisher","first-page":"2811","DOI":"10.1007\/s00264-025-06663-5","volume":"49","author":"P Hernigou","year":"2025","unstructured":"Hernigou P, Caton J (2025) Patellofemoral arthroplasty and chondrocalcinosis: a twenty-year follow-up. Int Orthop 49(12):2811\u20132818. https:\/\/doi.org\/10.1007\/s00264-025-06663-5","journal-title":"Int Orthop"},{"issue":"2","key":"6767_CR26","doi-asserted-by":"publisher","first-page":"134","DOI":"10.2106\/JBJS.24.00309","volume":"15","author":"Z Lyu","year":"2025","unstructured":"Lyu Z, Yang K, Yuan Z, Long T, Qu X, Yue B, Liu X, Wang Y (2025) Volume and distribution of early knee effusion after TKA with a PEEK-based knee prosthesis: correlation with changes in serum inflammation marker levels, knee functional score, and range of motion. J Bone Joint Surg Am 15(2):134\u2013143. https:\/\/doi.org\/10.2106\/JBJS.24.00309","journal-title":"J Bone Joint Surg Am"},{"issue":"10","key":"6767_CR27","doi-asserted-by":"publisher","first-page":"2477","DOI":"10.1007\/s00264-023-05907-6","volume":"47","author":"P Hernigou","year":"2023","unstructured":"Hernigou P, Karam S, Zhang N, Guo W, Ge J, Liu C, Zhang Q, Hernigou J (2023) Lateral meniscus with tears or with histologic calcification does not increase the risk of lateral osteoarthritis after medial unicompartmental arthroplasty. Int Orthop 47(10):2477\u20132485. https:\/\/doi.org\/10.1007\/s00264-023-05907-6","journal-title":"Int Orthop"},{"key":"6767_CR28","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1016\/j.joca.2006.08.012","volume":"15","author":"P Viriyavejkul","year":"2007","unstructured":"Viriyavejkul P, Wilairatana V, Tanavalee A, Jaovisidha K (2007) Comparison of characteristics of patients with and without calcium pyrophosphate dihydrate crystal deposition who underwent total knee replacement surgery for osteoarthritis. Osteoarthritis Cartilage 15:232\u2013235","journal-title":"Osteoarthritis Cartilage"}],"container-title":["International Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-026-06767-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00264-026-06767-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-026-06767-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T04:00:25Z","timestamp":1778904025000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00264-026-06767-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,3]]},"references-count":28,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["6767"],"URL":"https:\/\/doi.org\/10.1007\/s00264-026-06767-6","relation":{},"ISSN":["0341-2695","1432-5195"],"issn-type":[{"value":"0341-2695","type":"print"},{"value":"1432-5195","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,3]]},"assertion":[{"value":"6 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Informed consent was waived due to the retrospective design of the study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}