Joint replacement (primary): hip, knee and shoulder

Recommendation ID: NG157/6
Question: In adults having elective knee replacement, what is the clinical and cost effectiveness of total knee replacement with patella resurfacing compared with selective resurfacing?
Any explanatory notes (if applicable): Full details of the research recommendation are in evidence review L: patella resurfacing.

Why the committee made the recommendation

The committee looked at 3 options: resurfacing, no resurfacing and selective resurfacing. There was not enough clinical evidence to indicate whether any of the options was more beneficial than the others. However, strong economic evidence showed that resurfacing is cost effective compared with no resurfacing over a 10‑year time horizon because of reduced hospital readmissions. Because of the lack of clinical evidence, the committee also made a recommendation for research on selective resurfacing in knee replacement.

How the recommendation might affect practice

Current practice varies, with resurfacing carried out in around 35% to 40% of knee replacements. This recommendation can be expected to increase the number of knee replacement operations with patella resurfacing. There may be an initial increase in costs because of more costly hospital stays for resurfacing, but this is expected to be more than offset by reduced numbers of hospital readmissions in the long term.

Source guidance details

Is this a recommendation for the use of a technology only in the context of research?	No
Is it a recommendation that suggests collection of data or the establishment of a register?	No
Last Reviewed	01/06/2020