Abstract / Summary
Abstract Background Anterior knee pain (AKP) remains a frequent cause of dissatisfaction after primary total knee arthroplasty (TKA) without patellar resurfacing. Lateral partial patellar facetectomy (LPPF) may reduce lateral patellofemoral overload and improve patellar tracking, but clinical evidence remains limited. This study compared outcomes of primary non-resurfaced TKA performed with or without LPPF. Methods This retrospective comparative study included 303 consecutive patients who underwent primary non-resurfaced TKA between January 2023 and December 2024. Patients were divided into an LPPF group (n = 147) and a control group (n = 156). Clinical outcomes included anterior VAS pain, persistent AKP, Knee Society Score (KSS), Oxford Knee Score (OKS), Kujala score, range of motion, and satisfaction. Radiographic assessment included patellar tilt, congruence angle, lateral patellar displacement, and patellar height. Patellofemoral complications were recorded at a minimum follow-up of 12 months. Between-group comparisons used independent-samples Student’s t tests and Pearson’s chi-square or Fisher’s exact tests, as appropriate. Results Baseline characteristics were comparable between groups. At 12 months, the LPPF group showed significantly lower anterior VAS pain scores (1.39 ± 1.02 vs. 2.05 ± 1.14, p = 0.002) and a lower prevalence of persistent AKP (5.4% vs. 17.9%, p = 0.012). Functional outcomes were significantly better after LPPF, including KSS Knee (88.4 vs. 83.5, p < 0.001), KSS Function (83.9 vs. 78.1, p = 0.002), OKS (41.8 vs. 38.2, p = 0.003), and Kujala score (77.4 vs. 72.1, p = 0.001). Radiographic assessment showed improved patellofemoral alignment, with lower patellar tilt (3.61° vs. 6.88°, p < 0.001) and reduced lateral patellar displacement (0.76 vs. 2.35 mm, p < 0.001). The LPPF group also had higher patient satisfaction and fewer patellofemoral complications. Conclusions LPPF was associated with reduced AKP, improved functional outcomes, better patellofemoral alignment, and fewer complications after primary non-resurfaced TKA. These findings support LPPF as a simple adjunctive procedure in selected patients. Prospective randomized studies with longer follow-up are needed. Trial registration Not applicable.