{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T16:07:48Z","timestamp":1790957268695,"version":"4.1.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,3,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Patellar complications are a consequential cause of failure of primary total knee arthroplasty (TKA). The purpose of this study was to evaluate the association of demographic and patient factors with the long-term risk of patellar complications as a function of time in a very large cohort of primary TKAs performed with patellar resurfacing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We identified 27,192 primary TKAs utilizing cemented all-polyethylene patellar components that were performed at a single institution from 1977 through 2015. We evaluated the risk of any aseptic patellar complication and any aseptic patellar reoperation or revision, subanalyzed risks of reoperation or revision for loosening, maltracking\/instability, and wear, and evaluated the risk of clinical diagnosis of patellar fracture and clunk\/crepitus. The mean age at TKA was 68 years (range, 18 to 99 years); 57% of the patients were female. The mean body mass index (BMI) was 32 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . The primary diagnosis was osteoarthritis in 83%, and 70% of the TKAs were posterior-stabilized. Median follow-up was 7 years (range, 2 to 40 years). Risk factors for each outcome were evaluated with Cox regression models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Nine hundred and seventy-seven knees with all-polyethylene patellae developed patellar complications. Survivorship free from any aseptic patellar complication was 93.3% at 20 years. Twenty-year survivorship free from any aseptic patellar reoperation was 97.3% and free from any aseptic patellar revision was 97.4%. Fifteen-year survivorship for the same end points for procedures performed from 2000 to 2015 was 95.7%, 99.2% and 99.3% respectively, representing substantial improvements compared with implants placed before 2000. Univariate analysis demonstrated that male sex (hazard ratio [HR], 1.4), an age of &lt;65 years (HR, 1.3), and a BMI of \u226530 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      (HR, 1.2) were associated with increased risk of patellar complications (all p \u22640.01). Posterior-stabilized designs were associated with fewer patellar reoperations and revisions overall (HR, 0.4 and 0.4; p &lt; 0.001) but higher risk of patellar clunk\/crepitus (HR, 14.1; p &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      The 20-year survivorship free from any aseptic patellar complication in this series of cemented all-polyethylene patellae was 93%. Important risk factors for any aseptic patellar complication were male sex, an age of &lt;65 years, a BMI of \u226530 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , and a patella implanted before 2000.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.21.00356","type":"journal-article","created":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T14:05:55Z","timestamp":1640095555000},"page":"451-458","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":20,"title":["Factors Affecting the Risk of Aseptic Patellar Complications in Primary TKA Performed with Cemented All-Polyethylene Patellar Resurfacing"],"prefix":"10.2106","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4772-663X","authenticated-orcid":false,"given":"Afton K.","family":"Limberg","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2756-1353","authenticated-orcid":false,"given":"Meagan E.","family":"Tibbo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6910-0873","authenticated-orcid":false,"given":"Matthieu","family":"Ollivier","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Aix-Marseille Universit\u00e9, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1978-3490","authenticated-orcid":false,"given":"Nattapol","family":"Tammachote","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Bangkok Hospital, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2398-1724","authenticated-orcid":false,"given":"Matthew P.","family":"Abdel","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1422-0306","authenticated-orcid":false,"given":"Daniel J.","family":"Berry","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,12,21]]},"reference":[{"issue":"2","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/j.arth.2017.08.041","article-title":"Patellar Resurfacing in Total Knee Arthroplasty: Systematic Review and Meta-Analysis","volume":"33","author":"Longo","year":"2018","journal-title":"J Arthroplasty."},{"issue":"11","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"3206","DOI":"10.1007\/s00167-018-4831-8","article-title":"Patellar resurfacing versus patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses","volume":"26","author":"Grassi","year":"2018","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"1","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.arth.2016.06.010","article-title":"International Rates of Patellar Resurfacing in Primary Total Knee Arthroplasty, 2004-2014","volume":"32","author":"Fraser","year":"2017","journal-title":"J Arthroplasty."},{"issue":"5","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1302\/0301-620X.103B5.BJJ-2020-0598.R2","article-title":"Patellar resurfacing during primary total knee replacement is associated with a lower risk of revision surgery","volume":"103-B","author":"Hunt","year":"2021","journal-title":"Bone Joint J."},{"issue":"4","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/S0883-5403(99)90104-3","article-title":"Kinematic total knee arthroplasty: a 10- to 14-year prospective follow-up review","volume":"14","author":"Ewald","year":"1999","journal-title":"J Arthroplasty."},{"issue":"7","key":"bib6-20250430","first-page":"696","article-title":"Patellofemoral problems following total knee arthroplasty","volume":"17","author":"Doolittle","year":"1988","journal-title":"Orthop Rev."},{"issue":"4","key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.otsr.2019.01.025","article-title":"Have the frequency of and reasons for revision total knee arthroplasty changed since 2000? 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