Surgical procedure
patella resurfacing
All patients received cemented (Palacos R + G, Heraeus Medical, Wehrheim, Germany), fixed-bearing, cruciate-retaining Attune (DePuy Synthes, Warsaw, IN) TKA without patella resurfacing. Participants underwent the same standardized preoperative protocol and surgical technique. All surgeries were performed via the medial parapatellar approach and the tibia first method with the balancing of the flexion gap. After TKA surgery, all subjects received a standardized rehabilitation protocol under the supervision of a physiotherapist at the hospital. The protocol included full weight bearing immediately after surgery with the use of crutches, continuous passive motion (CPM) therapy, active ROM and strengthening exercises, and gait training. A standardized home-based exercise program was followed.