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Vasiliadis AV, Giovanoulis V. Patellar management in total knee arthroplasty: an educational aid. Singapore Med J 2024:00077293-990000000-00128. [PMID: 38993103 DOI: 10.4103/singaporemedj.smj-2023-154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/12/2023] [Indexed: 07/13/2024]
Affiliation(s)
- Angelo Vasileiou Vasiliadis
- Department of Orthopaedic Surgery, Sports Trauma Unit, St. Luke's Hospital, Thessaloniki, Greece
- Department of Orthopaedic Surgery and Sports Medicine, Croix-Rousse Hospital, Lyon, France
| | - Vasileios Giovanoulis
- Department of Orthopaedic Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
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Goicoechea N, Hinarejos P, Gasol B, Torres-Claramunt R, Sánchez-Soler J, Perelli S, Monllau JC. Systematic lateral retinacular release does not reduce anterior knee pain after total knee arthroplasty with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2023; 31:4213-4219. [PMID: 37270463 DOI: 10.1007/s00167-023-07456-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/13/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE The aim of this study was to assess the effect of systematic lateral retinacular release (LRR) on anterior knee pain (AKP), as well as its impact on the functional and radiological outcomes after total knee arthroplasty (TKA) with patellar resurfacing. METHODS A prospective randomized study was designed. It included patients scheduled for a TKA procedure with patellar resurfacing, who were recruited and randomized into either the LRR group or the non-release group. 198 patients were included in the final analysis. The pressure pain threshold (PPT) assessed by pressure algometry (PA), the visual analogue scale (VAS), Feller's patellar score, the Knee Society Score (KSS), patellar height, and patellar tilt were recorded both preoperatively and at the 1-year follow-up. The Mann-Whitney U test was performed to determine comparisons between both groups as well as to determine differences' intragroup. RESULTS Relative to the clinical variables and scores, no difference was detected between the two groups at the 1-year follow-up (p = n.s.). However, there was a slight difference in patellar tilt (0.1º vs. 1.4º, p = 0.044), with higher tilt values in the non-release group. There was no difference in terms of improvement in the clinical and radiological scores and variables recorded between the two groups (p = n.s.). CONCLUSION LRR in primary TKA with patellar resurfacing does not show an improvement in AKP and functional outcomes over patellar resurfacing without release. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Nerea Goicoechea
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain.
| | - Pedro Hinarejos
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Berta Gasol
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Raul Torres-Claramunt
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Juan Sánchez-Soler
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Simone Perelli
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Joan Carles Monllau
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
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Resection of Infrapatellar Fat Pad during Total Knee Arthroplasty Has No Impact on Postoperative Function, Pain and Sonographic Appearance of Patellar Tendon. J Clin Med 2022; 11:jcm11247339. [PMID: 36555955 PMCID: PMC9782688 DOI: 10.3390/jcm11247339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Routine resection of the infrapatellar fat pad (IFP) during total knee arthroplasty (TKA) is controversial, as it may result in shortening of the patellar tendon (PT) and anterior knee pain. This prospective study examined whether IFP excision during TKA affects joint function, anterior knee pain, PT dimensions and sonographic structure. A total of 65 consecutive patients undergoing TKA for osteoarthritis were randomized into two groups: IFP was resected in one and retained in the other. Patients were examined preoperatively, at 6 weeks and 6 months postoperatively: pain (Numerical Rating Scale-NRS), range of motion (ROM) and knee function (Knee Injury and Osteoarthritis Outcome Score-KOOS score) were evaluated; sonographic examination determined the length, structure and vascularity of the PTs. In both groups there were postoperative improvements in NRS and KOOS scores, although IFP resection did not influence clinical outcomes or sonographic parameters. At 6 weeks and 6 months postoperatively for both groups there were no differences between NRS scores (Mann-Whitney test, p = 0.511 and p = 0.579), ROM scores (Mann-Whitney test, p = 0.331, p = 0.180) or all KOOS subscores. IFP excision had no effect on sonographic parameters. This study suggests that IFP resection during TKA does not influence postoperative functional outcomes, pain scores, patellar tendon length and thickness, or sonographic structure.
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Park HJ, Chang MJ, Kim TW, Chang CB, Kang KS, Kang SB. Subchondral Bone Condition and Intraoperative Grading of Cartilage Degeneration Underneath Patella Unrelated to the Clinical Outcome after TKA with Unresurfaced Patella. J Knee Surg 2022; 35:1417-1424. [PMID: 33607675 DOI: 10.1055/s-0041-1723980] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The degree of cartilage degeneration assessed intraoperatively may not be sufficient as a criterion for patellar resurfacing in total knee arthroplasty (TKA). However, single-photon emission tomography/computed tomography (SPECT/CT) is useful for detecting osteoarthritic involvement deeper in the subchondral bone. The purpose of the study was to determine whether SPECT/CT reflected the cartilage lesion underneath the patella in patients with end-stage osteoarthritis (OA) and whether clinical outcomes after TKA without patellar resurfacing differed according to the severity of patellofemoral (PF) OA determined by visual assessment and SPECT/CT findings. This study included 206 knees which underwent TKA. The degree of cartilage degeneration was graded intraoperatively according to the International Cartilage Repair Society grading system. Subjects were classified into low and high uptake groups according to the degree of bone tracer uptake (BTU) on SPECT/CT in the PF joint. The Feller's patella score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed preoperatively and postoperative 1 and 2 years. The increased BTU in the PF joint was associated with more severe degenerative cartilage changes underneath the patella (p < 0.001). The risk for the presence of denudated cartilage was greater in the high uptake group (odds ratio = 5.89). There was no association between clinical outcomes and visual grading of patellar cartilage degeneration or the degree of BTU on SPECT/CT. The visual assessment of the degree of cartilage degeneration underneath the patella and preoperative SPECT/CT evaluation of the PF joint were not predictive of clinical outcome after TKA with unresurfaced patella.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kee Soo Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
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Fleaca S, Mohor C, Dura H, Chicea R, Mohor C, Boicean A, Roman M. Effect of patella resurfacing on functional outcome and revision rate in primary total knee arthroplasty (Review). Exp Ther Med 2021; 23:104. [DOI: 10.3892/etm.2021.11027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/21/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sorin Fleaca
- Department of Surgery, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Cosmin Mohor
- Department of Basic Science, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Horatiu Dura
- Department of Basic Science, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Radu Chicea
- Department of Surgery, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Calin Mohor
- Department of Basic Science, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Adrian Boicean
- Department of Medicine, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Mihai Roman
- Department of Surgery, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
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Goicoechea N, Hinarejos P, Torres-Claramunt R, Leal-Blanquet J, Sánchez-Soler J, Monllau JC. Patellar denervation does not reduce post-operative anterior knee pain after primary total knee arthroplasty with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2021; 29:3346-3351. [PMID: 32761276 DOI: 10.1007/s00167-020-06164-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Anterior knee pain (AKP) is a frequent symptom after a total knee arthroplasty (TKA). Patellar denervation (PD) has been put forth as a technique to reduce this pain; however, its effects have not been assessed in combination with patellar resurfacing. The aim of this study is to evaluate the effect of PD on AKP and functional outcomes after TKA with patellar resurfacing. METHODS A prospective study was designed that included patients scheduled for TKA with patellar resurfacing. The 202 recruited patients were randomized into either the PD group or the non-denervation group [mean age 72.7 years (SD 8.2); 119 (70.4%) women and 50 (29.6%) men; average body mass index 31.4 kg/m2 (SD 4.9)]. Pressure pain threshold (PPT) assessed by pressure algometry (PA), visual analogue scale(VAS), patellofemoral Feller score and the Knee Society Scores (KSS) were recorded preoperatively and at the 1-year follow-up. RESULTS 169 patients were included in data analysis. At the 1-year follow-up, there were mild differences between denervation and non-denervation group in PPT value (494.4 kPa vs. 552.3 kPa, p = 0.047) and in VAS at stairs (2.9 vs. 1.5, p = 0.003) in favour of the non-denervation group. There was no difference in the improvement between groups in patellofemoral Feller score and KSS, but slightly higher improvement in non-denervation group in PPT (94.1 kPa vs. 160 kPa, p = 0.047), VAS walking (5.3 vs. 6.2, p = 0.041) and VAS at stairs (4.6 vs. 5.7, p = 0.022). CONCLUSION Patellar denervation does not improve AKP and clinical outcomes in primary TKA with patellar resurfacing compared to patellar replacement without denervation. PD cannot be recommended when patellar replacement is performed in TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Nerea Goicoechea
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain.
| | - Pedro Hinarejos
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Raul Torres-Claramunt
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Joan Leal-Blanquet
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Juan Sánchez-Soler
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Joan Carles Monllau
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
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Held MB, Gazgalis A, Sarpong NO, Geller JA, Shah RP, Cooper HJ. Management of the Patella During Total Knee Arthroplasty. JBJS Rev 2021; 9:01874474-202109000-00011. [PMID: 34516451 DOI: 10.2106/jbjs.rvw.21.00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The optimal management of the patella during total knee arthroplasty (TKA) remains a controversial topic with no consensus. » Patellar management techniques during TKA include patellar retention or resurfacing with or without patellaplasty, as well as circumferential denervation and partial lateral facetectomy (PLF). » Special considerations such as patient age, etiology of disease, implant design, and surgeon preference should be accounted for when determining optimal management. » We recommend that most patellae be circumferentially denervated, regardless of whether they are resurfaced, as the potential benefits outweigh the small associated risks. » Evidence demonstrates improved functional outcomes with the addition of PLF to nonresurfaced patellae. There is currently a paucity of evidence of this technique with respect to resurfaced patellae. » Patellar resurfacing adds additional costs and health-care resources that should be considered in the decision-making process.
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Affiliation(s)
- Michael B Held
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
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Qin Y, Pu C, Zhou Y, Yu J, Tang J. Influence of patellar denervation on anterior knee pain and knee function following total knee replacement: A systematic review and meta-analysis. ANZ J Surg 2021; 91:E690-E695. [PMID: 34291537 DOI: 10.1111/ans.17078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies have reached mixed results regarding the effects of patellar denervation with electrocautery (PD) on total knee replacement (TKR). This systematic review and meta-analysis aimed to summarize all available literatures to investigate the influence of PD on postoperative anterior knee pain (AKP) and knee function after TKR. METHODS Electronic databases, including PubMed, Cochrane Library and Embase, were searched from their inception to March 2021. Randomized controlled trials (RCT) and quasi-randomized controlled trials (quasi-RCT) comparing PD and non-patellar denervation (NPD) in TKR were selected, and the Cochrane risk of bias tool was used to assess the quality of included trials. AKP prevalence was defined as the primary outcome. RESULTS A total of 12 RCTs and one quasi-RCT enrolled 1895 knees proved eligible. PD knees had significantly lower AKP prevalence than NPD knees (odds ratio [OR] = 0.54; 95% confidence intervals [95% CI], 0.36-0.81; p = 0.003). There was no difference between PD and NPD in terms of visual analogue scale for knee pain and range of motion, American knee society knee score, American knee society function score, patellar feller score, Oxford knee score for knee function. The results of subgroup analysis based on follow-up duration and patella resurfacing were in accordance with the results. PD knees were not associated with a higher risk of complication or revision. CONCLUSION PD can significantly reduce the AKP prevalence following TKR without increasing the risk of complication and revision. Although the pain relief effect of PD may not be associated with improved knee function after TKR, this procedure is preferred in both patella resurfacing and patella non-resurfacing TKR.
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Affiliation(s)
- Yongzhi Qin
- Department of Orthopaedics, The People's Hospital, Guang'an, China
| | - Chuancheng Pu
- Department of Orthopaedics, The People's Hospital, Guang'an, China
| | - Yong Zhou
- Department of Orthopaedics, The People's Hospital, Guang'an, China
| | - Jiang Yu
- Department of Orthopaedics, The People's Hospital, Guang'an, China
| | - Jing Tang
- Department of Orthopaedics, The People's Hospital, Guang'an, China.,Intensive Care Unit, Tthe People's Hospital, Guang'an, China
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Arulsingh W, Kandakurti PK, Muthukrishnan R, Shanmugam S. Effectiveness of neural mobilisation combined with postural correction exercises in a patient with lateral knee pain- A case report. J Bodyw Mov Ther 2021; 27:364-367. [PMID: 34391259 DOI: 10.1016/j.jbmt.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 01/27/2021] [Accepted: 02/28/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Distinguishing intraarticular lesion from extraarticular lesion need a thorough clinical evaluation in case of atraumatic knee pain. The main objective of this case report was to describe about the clinical course of a patient with unrelenting symptoms with suspected lateral meniscus lesion. CASE DESCRIPTION A 48-year old man was diagnosed with suspected lesion in the anterior horn of lateral meniscus for 9 months had received pharmacological and physiotherapy interventions. Yet the patient did not respond favourably to former symptomatic treatment. As the history and objective evaluation consistently matched with abnormal neurodynamics, in the similar line, the patient was treated with neural mobilization in a modified slump position, 15 repetitions per session for three consecutive days combined with postural correction exercises. RESULT The outcomes were measured with numeric pain rating scale (NPRS) and knee society scale (KSS). The patient responded very well to neural mobilization combined with postural correction exercises. The NPRS (4 at rest; 7 on activity) before our intervention reduced to (0 at rest, 1 on activity) at the end of 3 rd consecutive day intervention and the KSS improved to 75 from 55 in pain score & 90 from 80 on function score. At 2-months follow-up, the patient completely recovered from pain and knee dysfunction. CONCLUSION This case report signifies that abnormal neurodynamics can be a factor for lateral knee pain. Neural mobilization with postural correction exercises may be recommended as an appropriate treatment for patient with lateral-knee-pain due to abnormal neurodynamics.
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Affiliation(s)
- Watson Arulsingh
- College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates.
| | | | | | - Sukumar Shanmugam
- College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
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Molfetta L, Casabella A, Palermo A. The Patellar Resurfacing in Total Knee Prosthesis: Indications for Bone Stock and Patellar Morphology. Front Med (Lausanne) 2021; 7:405. [PMID: 33718393 PMCID: PMC7943458 DOI: 10.3389/fmed.2020.00405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/29/2020] [Indexed: 11/15/2022] Open
Abstract
The patellar resurfacing is still a controversial and unresolved problem. The choice to use the patellar resurfacing in the total knee prosthesis (TKP) is decided by the surgeon's experience; he analyzes the thickness, the shape, consumption of the surface and he chooses the use of patellar resurfacing or to limit itself to cheiloplasty, denervation, or often to the release of the lateral wing ligament. He also assesses the metabolic state of the bone linked to Osteoporosis and the potential fragility of the joint and kneecap in particular. Bone loss after total knee arthroplasty (TKP) may lead to periprosthetic fractures that are associated with significant costs (morbidity, economic, etc.) and pose a challenge to operative fixation. The literature doesn't express a definitive judgment on the two options, since the results can be overlapped on average. Each option has advantages and disadvantages to be considered in the overall balance of the patellar operation. In reality, however, this technical choice requires more consolidated decision-making criteria so as to minimize the incidence of post-surgical femoral-patellar pain syndrome, the second cause of failure, which frequently leads to revision of the implant. The balance between experience and evidence can be a compromise in the choice of surgery. The experience documented in the literature must identify the parameters capable of constructing an algorithm aimed not only at the secondary resurfacing rate, but at the overall clinical evaluation. This has implications also for the rehabilitation of these patients after surgery.
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Affiliation(s)
- Luigi Molfetta
- DISC Department, Research Centre of Osteoporosis and Osteoarticular Disease, School of Medical and Pharmaceutical Sciences, University of Genoa, Genoa, Italy
| | - Andrea Casabella
- DISC Department, Research Centre of Osteoporosis and Osteoarticular Disease, School of Medical and Pharmaceutical Sciences, University of Genoa, Genoa, Italy
| | - Augusto Palermo
- Unit of Orthopaedic Surgery, IRCCS Istituto Auxologico Italiano, Capitanio Hospital, Milan, Italy
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Yuan M, Ding Z, Ling T, Zhou Z. Patellar Denervation with Electrocautery Reduces Anterior Knee Pain within 1 Year after Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials. Orthop Surg 2021; 13:14-27. [PMID: 33354916 PMCID: PMC7862158 DOI: 10.1111/os.12735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The effect of patellar denervation with electrocautery (PD) on anterior knee pain (AKP) after total knee arthroplasty (TKA) is still debated. The aim of this meta-analysis was to evaluate the current evidence regarding the use of PD in TKA without patellar resurfacing. METHODS A computerized search of published studies was performed in the PubMed, Embase and Cochrane Library databases in December 2019. Eligible studies were randomized controlled trials (RCTs) comparing clinical outcomes of the PD group and the non-PD group. Subgroup analyses were carried out according to the follow-up time (3, 12 months, and over 12 months) to evaluate whether the clinical effect of PD changed with time. RESULTS Ten RCTs were included in this meta-analysis. Pooled results showed a lower rate of AKP (Risk Ratio [RR] = 0.70; 95% confidence interval [CI], 0.50 to 0.97; P = 0.03) and a reduction in visual analogue scale (VAS) for AKP (mean difference, -0.37; 95% CI, -0.69 to -0.05; P = 0.02) in the PD group when compared to the non-PD group. Subgroup analyses found the differences in AKP incidence and VAS for AKP were significant at 3- and 12-month follow-up but not after 12-month follow-up. No significant difference was observed in functional scores between the two groups. No specific complication directly or indirectly related to PD was found. CONCLUSION PD can decrease the incidence and severity of AKP within 12 months after TKA, but the effect cannot be maintained after 12-month follow-up. Without significant associated complication and reoperation, the use of PD is still recommended in TKA without patellar resurfacing.
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Affiliation(s)
- Ming‐cheng Yuan
- Department of OrthopedicsWest China Hospital/West China School of Medicine, Sichuan UniversityChengdu610041China
| | - Zi‐chuan Ding
- Department of OrthopedicsWest China Hospital/West China School of Medicine, Sichuan UniversityChengdu610041China
| | - Ting‐xian Ling
- Department of OrthopedicsWest China Hospital/West China School of Medicine, Sichuan UniversityChengdu610041China
| | - Zongke Zhou
- Department of OrthopedicsWest China Hospital/West China School of Medicine, Sichuan UniversityChengdu610041China
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Chen K, Dai X, Li L, Chen Z, Cui H, Lv S. Patellar resurfacing versus nonresurfacing in total knee arthroplasty: an updated meta-analysis of randomized controlled trials. J Orthop Surg Res 2021; 16:83. [PMID: 33494774 PMCID: PMC7830853 DOI: 10.1186/s13018-020-02185-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/25/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Whether resurface the patella or not in total knee arthroplasty (TKA) was controversial. In 2013, we conducted a meta-analysis of randomized controlled trials (RTCs). After that, plenty of studies have been carried out, but there still existed a great deal of controversy. In order to update our previous study, we conducted this update meta-analysis to evaluate the efficacy of patellar resurfacing in TKA. METHODS Databases were searched for RCTs comparing the outcomes of patellar resurfacing and nonresurfacing in TKA. Outcomes of knee relevant indicators were analysed. To see the short- and long-term effects, we calculated the data in total and divided the patients who were followed up for ≤ 3 years and ≥ 5 years into two subgroups as well. RESULTS Thirty-two trials assessing 6887 knees were eligible. There was a significant difference in terms of reoperation (in total and ≥ 5 years), Knee Society Score (KSS), function score (in total and ≥ 5 years) and noise. While no significant difference was found in the following items: reoperation (≤ 3 years), anterior knee pain (AKP), function score (≤ 3 years), range of motion (ROM), Oxford score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analogue score (VAS), Feller score, patellar tilt and the patients' satisfaction. CONCLUSIONS We found that patellar resurfacing could reduce the occurrence of reoperation and noise after surgery, as well as increase the KSS and function score, while it might not influence the outcomes such as AKP, ROM, Oxford score, KOOS, VAS, Feller score, patellar tilt and the patients' satisfaction. The results are different from our previous finding in the meta-analysis. In conclusion, we prefer patellar resurfacing in TKA.
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Affiliation(s)
- Kai Chen
- Department of Orthopedic Surgery, Hai'an People's Hospital, Zhongba Road 17, Hai'an, Nantong, 226600, Jiangsu, People's Republic of China
| | - Xiaoyu Dai
- Department of Orthopedic Surgery, The First People's Hospital of Changzhou Affiliated to Soochow University, Juqian Road 185, Changzhou, 213000, Jiangsu, People's Republic of China
| | - Lidong Li
- Department of Orthopedic Surgery, Hai'an People's Hospital, Zhongba Road 17, Hai'an, Nantong, 226600, Jiangsu, People's Republic of China
| | - Zhigang Chen
- Department of Orthopedic Surgery, Hai'an People's Hospital, Zhongba Road 17, Hai'an, Nantong, 226600, Jiangsu, People's Republic of China
| | - Haidong Cui
- Department of Orthopedic Surgery, Hai'an People's Hospital, Zhongba Road 17, Hai'an, Nantong, 226600, Jiangsu, People's Republic of China
| | - Shujun Lv
- Department of Orthopedic Surgery, Hai'an People's Hospital, Zhongba Road 17, Hai'an, Nantong, 226600, Jiangsu, People's Republic of China.
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Shen XY, Zuo JL, Gao JP, Liu T, Xiao JL, Qin YG. New treatment of patellar instability after total knee arthroplasty: A case report and review of literature. World J Clin Cases 2020; 8:5487-5493. [PMID: 33269288 PMCID: PMC7674709 DOI: 10.12998/wjcc.v8.i21.5487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/19/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patellar instability is an uncommon complication after total knee arthroplasty (TKA). Partial lateral patella facetectomy (LPF) with lateral retinaculum release treatment of patellar instability is rarely reported.
CASE SUMMARY We present a case of patellar instability 8 mo after primary TKA. Treatment of this complication was adapted to address the cause of the dislocation. To eliminate patellar instability, we restored the vastus medialis and performed LPF with lateral retinaculum release. We achieved normal patellar tracking. Clinical and radiographic evaluations at the 1-year postoperative follow-up were satisfactory.
CONCLUSION LPF with lateral retinaculum release represents a promising option to restore central patellar tracking in patients with patellar instability after TKA in cases without component malposition.
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Affiliation(s)
- Xian-Yue Shen
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Jian-Lin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Jian-Peng Gao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Tong Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Jian-Lin Xiao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Yan-Guo Qin
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
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Wang Y, Feng W, Zang J, Gao H. Effect of Patellar Denervation on Anterior Knee Pain and Knee Function in Total Knee Arthroplasty without Patellar Resurfacing: A Meta-Analysis of Randomized Controlled Trials. Orthop Surg 2020; 12:1859-1869. [PMID: 33112040 PMCID: PMC7767783 DOI: 10.1111/os.12815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/05/2020] [Accepted: 08/25/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate the effect of patellar denervation (PD) in preventing anterior knee pain (AKP) and improving knee function after total knee arthroplasty (TKA) without patellar resurfacing, and to help surgeons decide whether or not to use PD in TKA. METHODS The electronic databases of Pubmed, Embase, Cochrane, Web of Science, and Scopus were searched for all randomized controlled trials (RCT) comparing the outcomes of PD and no patellar denervation (NPD) in TKA without patellar resurfacing. Primary outcomes were incidence of AKP, visual analogue scale for pain (VAS), and patellar score (PS). Secondary outcomes were Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Knee Score (OKS), knee range of motion (ROM), and complications. RESULTS A total of nine RCT met the inclusion criteria. On meta-analysis, PD significantly reduced the incidence of AKP (odds ratio 0.49; 95% confidence interval [CI] 0.26 to 0.92), reduced the VAS (weighted mean difference [WMD] -0.57; 95% CI -1.02 to -0.11), and improved the WOMAC (WMD -4.63; 95% CI -6.49 to -2.77) and the ROM (WMD 9.60; 95% CI 0.39 to 18.81) during the follow-up within 12 months. In addition, PD improved the PS (WMD 1.01; 95% CI 0.65 to 1.38), KSS (WMD 1.12; 95% CI 0.10 to 2.14), and the WOMAC (WMD -1.41; 95% CI -2.74 to -0.08) during the follow-up after 12 months. CONCLUSION Patellar denervation could significantly reduce the VAS and the incidence of AKP in the early stages after TKA as well as improve the clinical outcomes in terms of the PS, the WOMAC, the KSS, and the ROM. This study demonstrates that PD is a safe and recommendable technique that could be routinely performed in TKA.
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Affiliation(s)
- Yuhang Wang
- Day Care Unit, The First Hospital of Jilin University, Changchun, China
| | - Wei Feng
- Department of Orthopaedics, The First Hospital of Jilin University, Changchun, China
| | - Junting Zang
- Department of Orthopaedics, The First Hospital of Jilin University, Changchun, China
| | - Hang Gao
- Department of Orthopaedics, The First Hospital of Jilin University, Changchun, China
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Does Circumferential Patellar Denervation Result in Decreased Knee Pain and Improved Patient-reported Outcomes in Patients Undergoing Nonresurfaced, Simultaneous Bilateral TKA? Clin Orthop Relat Res 2020; 478:2020-2033. [PMID: 32023234 PMCID: PMC7431264 DOI: 10.1097/corr.0000000000001035] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior knee pain, which has a prevalence of 4% to 49% after TKA, may be a cause of patient dissatisfaction after TKA. To limit the occurrence of anterior knee pain, patellar denervation with electrocautery has been proposed. However, studies have disagreed as to the efficacy of this procedure.Questions/purposes We evaluated patients undergoing bilateral, simultaneous TKA procedures without patellar resurfacing to ask: (1) Does circumferential patellar cauterization decrease anterior knee pain (Kujala score) postoperatively compared with non-cauterization of the patella? (2) Does circumferential patellar cauterization result in better functional outcomes based on patient report (VAS score, Oxford knee score, and Knee Injury and Osteoarthritis Outcome Score) than non-cauterization of the patella? (3) Is there any difference in the complication rate (infection, patellar maltracking, fracture, venous thromboembolism, or reoperation rate) between cauterized patellae and non-cauterized patellae? METHODS Seventy-eight patients (156 knees) were included in this prospective, quasi-randomized study, with each patient serving as his or her own control. Patellar cauterization was always performed on the right knee during simultaneous, bilateral TKA. Five patients (6%) were lost to follow-up before the 2-year minimum follow-up interval. A single surgeon performed all TKAs using the same type of implant, and osteophyte excision was performed in all patellae, which were left unresurfaced. Patellar cauterization was performed at 2 mm to 3 mm deep and approximately 5 mm circumferentially away from the patellar rim. The preoperative femorotibial angle and degree of osteoarthritis (according to the Kellgren-Lawrence grading system) were measured. Restoration of the patellofemoral joint was assessed using the anterior condylar ratio. Clinical outcomes, consisting of clinician-reported outcomes (ROM and Kujala score) and patient-reported outcomes (VAS pain score, Oxford knee score, and Knee Injury and Osteoarthritis Outcome Score), were evaluated preoperatively and at 1 month and 2 years postoperatively. Preoperatively, the radiologic severity of osteoarthritis, based on the Kellgren-Lawrence classification, was not different between the two groups, nor were the baseline pain and knee scores. The mean femorotibial angle of the two groups was also comparable: 189° ± 4.9° and 191° ± 6.3° preoperatively (p = 0.051) and 177° ± 2.9° and 178° ± 2.1° postoperatively (p = 0.751) for cauterized and non-cauterized knees, respectively. The preoperative (0.3 ± 0.06 versus 0.3 ± 0.07; p = 0.744) and postoperative (0.3 ± 0.06 versus 0.2 ± 0.07; p = 0.192) anterior condylar ratios were also not different between the cauterized and non-cauterized groups. RESULTS At the 2-year follow-up interval, no difference was observed in the mean Kujala score (82 ± 2.9 and 83 ± 2.6 for cauterized and non-cauterized knees, respectively; mean difference 0.3; 95% confidence interval, -0.599 to 1.202; p = 0.509). The mean VAS pain score was 3 ± 0.9 in the cauterized knee and 3 ± 0.7 in the non-cauterized knee (p = 0.920). The mean ROM was 123° ± 10.8° in the cauterized knee and 123° ± 10.2° in the non-cauterized knee (p = 0.783). There was no difference between cauterized and non-cauterized patellae in the mean Knee Injury and Osteoarthritis Outcome Score for symptoms (86 ± 4.5 versus 86 ± 3.9; p = 0.884), pain (86 ± 3.8 versus 86 ± 3.6; p = 0.905), activities (83 ± 3.2 versus 83 ± 2.8; p = 0.967), sports (42 ± 11.3 versus 43 ± 11.4; p = 0.942), and quality of life (83 ± 4.9 versus 83 ± 4.7; p = 0.916), as well as in the Oxford knee score (40 ± 2.1 versus 41 ± 1.9; p = 0.771). Complications were uncommon and there were no differences between the groups (one deep venous thromboembolism in the cauterized group and two in the control group; odds ratio 0.49, 95% CI, 0.04-5.56; p = 0.57). CONCLUSIONS Patellar cauterization results in no difference in anterior knee pain, functional outcomes, and complication rates compared with non-cauterization of the patella in patients who undergo non-resurfaced, simultaneous, bilateral, primary TKA with a minimum of 2 years of follow-up. We do not recommend circumferential patellar cauterization in non-resurfaced patellae in patients who undergo TKA. LEVEL OF EVIDENCE Level II, therapeutic study.
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Park KJ, Lambert BS, Brown LD, Le DT, Chaliki K, Lee J, Rossano A, Benjamin K, Moreno MR, Incavo SJ. The Usefulness of Meta-Analyses to Hip and Knee Surgeons. J Bone Joint Surg Am 2019; 101:2082-2090. [PMID: 31800421 DOI: 10.2106/jbjs.19.00420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Comprehensive systematic reviews of results from homogenous or heterogeneous clinical trials, meta-analyses are used to summarize and to interpret studies. Proponents believe that their use can increase study power and improve precision results. Critics emphasize that heterogeneity between studies and bias of individual studies compromise the value of results. The methodology of meta-analyses has improved over time, utilizing statistical analysis to reduce bias and examining heterogeneity. With an increasing trend of meta-analyses in orthopaedic literature, this study aimed to investigate quality and clinical utility of meta-analyses for total knee arthroplasty and total hip arthroplasty. METHODS A systematic review of total knee arthroplasty and total hip arthroplasty meta-analyses in 3 major orthopaedic journals from January 2000 to August 2017 was performed. Three authors independently reviewed eligible meta-analyses. A quality assessment was conducted using the Oxman-Guyatt Index. Reporting quality was assessed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two high-volume, fellowship-trained, attending surgeons specializing in total hip arthroplasty and total knee arthroplasty independently, in a blinded fashion, reviewed 24 of the highest-scored meta-analyses. RESULTS There were 114 studies meeting eligibility criteria, 25 published from 2000 to 2009 and 89 published from 2010 to 2017, a 3.6-fold increase. The mean Oxman-Guyatt Index score was 3.89 points, with 12 high-quality studies, 87 moderate-quality studies, and 15 low-quality studies. The mean PRISMA score for all meta-analyses was 22.2 points, with 79% classified as low to moderate. Only 23 studies listed the Level of Evidence, and 8 were Level-I studies and 9 were Level-II studies. Studies with >15 randomized controlled trials were associated with higher PRISMA and Oxman-Guyatt Index scores. In 12 articles, we were unable to decipher the types of studies included. Only 39.4% of studies showed the risk of bias. Of the 24 studies identified as high quality per the PRISMA statement, 71% were determined to be either clinically unimportant or inconclusive. CONCLUSIONS The number of total hip arthroplasty and total knee arthroplasty meta-analyses has markedly increased over the past decades. The majority of published meta-analyses from 3 major orthopaedic journals were not performed in accordance with established PRISMA guidelines. CLINICAL RELEVANCE Many published meta-analyses are low to moderate quality, and clinicians should cautiously draw conclusions from poorly executed meta-analyses.
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Affiliation(s)
- Kwan J Park
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Bradley S Lambert
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
- Department of Mechanical Engineering, Texas A&M University, College Station, Texas
| | - Landon D Brown
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Daniel T Le
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Kalyan Chaliki
- Department of Kinesiology, Rice University, Houston, Texas
| | - Joshua Lee
- Department of Kinesiology, Rice University, Houston, Texas
| | - Ayane Rossano
- Department of Kinesiology, Rice University, Houston, Texas
| | | | - Michael R Moreno
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
- Department of Mechanical Engineering, Texas A&M University, College Station, Texas
| | - Stephen J Incavo
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
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Wu X, Sun H, Zhou X, Wang J, Li J. Quality assessment of systematic reviews on total hip or knee arthroplasty using mod-AMSTAR. BMC Med Res Methodol 2018; 18:30. [PMID: 29548276 PMCID: PMC5857117 DOI: 10.1186/s12874-018-0488-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 02/28/2018] [Indexed: 02/05/2023] Open
Abstract
Background Increasing numbers of systematic reviews (SRs) on total knee arthroplasty (TKA) and total hip arthroplasty (THA) have been published in recent years, but their quality has been unclear. The purpose of this study is to evaluate the methodological quality of SRs on TKA and THA. Methods We searched Ovid-Medline, Ovid-Embase, Cochrane Databases (including HTA, DARE, and CDSR), CBM, CNKI, Wang Fang, and VIP, from January 2014 to December 2015 for THA and TKA. The quality of SRs was assessed using the modified 25-item “Assessment of Multiple Systematic Reviews” (mod-AMSTAR) tool, which was based on the AMSTAR scale. A T-test, nonparametric test, and linear regression were conducted to assess the relationship between bibliographical characteristics and methodological quality. Results Sixty-three SRs were included, from which the majority of SRs (50, 79.4%) were conducted in Asia. Only 4 reviews were rated as high quality, and most were weak in providing a priori design (6, 9.5%), not limiting the publication type (8, 13%), providing an excluded primary studies list (4, 6.3%) and reporting support for the included primary studies (1, 1.6%). Reviews published in English journals performed better than did Chinese journals in duplicate data extraction (81.3% vs 46.7%, p = 0.017; 70.8% vs 33.3%, p = 0.009) and providing source of support for the SR (87.5% vs 33.3%, P < 0.001). Reviews published in journals with a higher impact factor were associated with a higher mod-AMSTAR score (regression coefficient: 0.38, 95%CI: 0.11–0.65; P = 0.006). Conclusion The methodological quality of the included SRs is far from satisfactory. Authors of SRs should conform to the recommendations outlined in the mod-AMSTAR items. Areas needing improvement were providing a priori design, not limiting the publication type, providing an excluded primary studies list, and reporting conflicts of interest. Electronic supplementary material The online version of this article (10.1186/s12874-018-0488-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xinyu Wu
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Huan Sun
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaoqin Zhou
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Ji Wang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Li
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
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[Anterior knee pain after total knee arthroplasty : Causes, diagnosis and treatment]. DER ORTHOPADE 2017; 45:386-98. [PMID: 27125231 DOI: 10.1007/s00132-016-3256-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Anterior knee pain is one of the most common complications after total knee arthroplasty. An incidence of up to 30 % has been reported in peer-reviewed studies. TARGET The purpose of this study was to systematically review the literature and to identify determinants that have been analyzed with regard to anterior knee pain. CAUSES Patient- and knee-specific characteristics, prosthetic designs and operative techniques are addressed as well as functional and neurologic determinants. Instability, increased contact pressure in the patellofemoral joint and patella maltracking due to malrotation of components, offset errors, ligament insufficiencies or patella baja are mechanical reasons for anterior knee pain. Functional causes include pathologic gait patterns, quadriceps imbalance and dynamic valgus. They have to be differentiated from infectious and inflammatory causes as well as soft tissue impingement, arthrofibrosis and neurologic diseases. TREATMENT A differentiated treatment algorithm is recommended. Often conservative treatment options exist, however, particularly with most mechanical causes revision surgery is necessary.
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Cameron-Donaldson ML, Ifran NN, Budhiparama NC. Selective patellar resurfacing with or without denervation as the ultimate answer: current concepts. J ISAKOS 2016. [DOI: 10.1136/jisakos-2016-000095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Spencer BA, Cherian JJ, Margetas G, Chughtai M, Harwin SF, Elmallah RK, Mont MA. Patellar Resurfacing Versus Circumferential Denervation of the Patella in Total Knee Arthroplasty. Orthopedics 2016; 39:e1019-23. [PMID: 27398783 DOI: 10.3928/01477447-20160623-14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/19/2015] [Indexed: 02/03/2023]
Abstract
This study compared the rates of anterior knee pain and functional outcomes between resurfaced patellas and non-resurfaced patellas with a circumpatellar denervation. One hundred ten patients who underwent patellar resurfacing or a circumpatellar denervation were evaluated for knee pain and functional outcomes at a minimum of 2 years after total knee arthroplasty. There were no significant differences between the 2 groups regarding Knee Society Scores, anterior knee pain scores, or visual analog scale scores. The groups had similar incidences of anterior knee pain. Most patients reported no to mild effect of anterior knee pain on daily living. Patients in each group reported increased pain with kneeling, squatting, and departing an automobile. Similar proportions of patients were disappointed with their overall outcomes in each group. Circumpatellar denervation and patellar resurfacing during total knee arthroplasty lead to similar incidences of anterior knee pain. [Orthopedics. 2016; 39(5):e1019-e1023.].
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Is patellar denervation necessary in total knee arthroplasty without patellar resurfacing? Knee Surg Sports Traumatol Arthrosc 2016; 24:2541-9. [PMID: 26423054 DOI: 10.1007/s00167-015-3811-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/22/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE To conduct a meta-analysis with randomized controlled trials (RCTs) published in full text to determine the effectiveness of patellar denervation (PD) in primary total knee arthroplasty (TKA). METHODS Literature search was performed in PubMed, Embase, Web of Science and Cochrane Library for information from the earliest date of data collection to February 2015. RCTs comparing the benefits and risks of PD with those of no patellar denervation (NPD) in primary TKAs were included. Statistical heterogeneity was quantitatively evaluated by X(2) test with the significance set P < 0.10 or I (2) > 50 %. RESULTS Six RCTs consisting of 751 patients were included. The incidences of AKP in PD group and NPD group were 38.3 % (90/235) and 46.3 % (107/231), respectively. Meta-analysis showed significant prevention effect of PD on the incidence of AKP (OR 0.65; 95 % CI 0.42, 1.00; P = 0.05) without significant heterogeneity (I (2) = 44 %, P = 0.15). Our results also indicated that PD was significantly associated with better American Knee Society knee (WMD = 2.50; 95 % CI 0.34, 4.67; P = 0.02) and functional scores (WMD = 4.07; 95 % CI 1.34, 6.80; P = 0.0003) and range of motion (ROM) (WMD = 4.27; 95 % CI 1.95, 6.60; P = 0.0003) compared with NPD. However, there was no significant difference between the two groups no matter in Oxford knee score, patellar score or visual analogue scale at any other time. Complications and revisions did not differ significantly between the two groups. CONCLUSION This meta-analysis showed that PD in TKAs without patellar resurfacing, compared with NPD, could prevent the incidence of post-operative AKP and improve clinical outcome in KSS and post-operative ROM. Based on the above results, PD was a safe procedure with no significant complications and revision or re-operations. LEVEL OF EVIDENCE Therapeutic study, Level II.
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Does patellar denervation reduce post-operative anterior knee pain after total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 2015; 23:1808-15. [PMID: 25758982 DOI: 10.1007/s00167-015-3566-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 03/02/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE The effectiveness of patellar denervation in reducing anterior knee pain and improving patient satisfaction and quality of life after total knee arthroplasty (TKA) is still controversial. A meta-analysis was conducted to try to settle the controversy. METHODS The electronic databases PubMed, Web of Science, Embase, and Cochrane Library were systematically searched. Of 374 papers identified, seven randomised controlled trials involving 898 patients (983 knees) were eligible for data extraction and meta-analysis. RESULTS Analysis showed that patellar denervation can significantly improve clinical outcomes for the first 12 months of follow-up after TKA, including anterior knee pain incidence (P = 0.008), visual analogue scale score (P < 0.001), patellar score (P < 0.001), Knee Society Score (P = 0.03), Knee Society Score function score (P = 0.03), and knee range of motion (P = 0.008). However, no statistical significance in outcomes was found between the patellar denervation group and no-denervation group for any of those parameters after 12 months of follow-up. CONCLUSION The best currently available evidence suggests that patellar denervation can significantly reduce anterior knee pain incidence and improve early clinical outcomes after TKA. However, after a prolonged period of follow-up, this advantage seems to disappear. Even so, the use of patellar denervation in primary TKA is recommended because it is safe and produces good early clinical outcomes. LEVEL OF EVIDENCE Therapeutic study, Level II.
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