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Liu F, Duan M, Fu H, Wang T. The efficacy and safety of perioperative glucocorticoid for total knee arthroplasty: a systematic review and meta-analysis. BMC Anesthesiol 2024; 24:144. [PMID: 38622510 PMCID: PMC11017604 DOI: 10.1186/s12871-024-02530-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 04/08/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND An increasing number of individuals undergo total knee arthroplasty (TKA), which can result in pain, limited motor function and adverse complications such as infection, nausea and vomiting. Glucocorticoids have been shown anti-inflammatory and antiemetic effects, but can also elevate blood glucose levels and increase the risk of wound infection. Thus, it is essential to investigate the efficacy and safety of glucocorticoid usage in TKA. METHOD A comprehensive systematic search of PubMed, Medline, EMBASE, Cochrane databases, to identify relevant randomized controlled trials (RCTs) of glucocorticoid application in TKA. The primary outcomes assessed were the postoperative pain assessment. Secondary outcomes included the range of motion in knee joint, levels of inflammatory cytokines, adverse complications, and the length of hospital stay. RESULTS Thirty-six randomized controlled trials were included in the final analysis. The glucocorticoid group exhibited significant reduction in the resting VAS scores on postoperative days 1, 2 (POD1, 2)and postoperative 3 months (POM3), as well as decreased morphine consumption on POD1 and increased range of motion (ROM) in knee joint on POD1, 3. Additionally, the glucocorticoid group exhibited decreased levels of postoperative inflammatory cytokines and the incidence of PONV along with a shorter length of hospital stay. The blood glucose concentration was significantly increased in the glucocorticoid group on POD1 compared with the control group. While the blood glucose on POD2 and occurrence of postoperative adverse complications were similar between two groups including wound infection and venous thrombosis. The periarticular injection analgesia (PIA) group demonstrated lower VAS scores on POD2 comparing to the systemic administration (SA) group according to two studies. However, there was no significant difference of the resting VAS on POD1 and POD2 between PIA and SA group across all studies. CONCLUSION Perioperative glucocorticoids treatment in TKA significantly reduced short-term pain score and opioid-use which was probably not patient relevant. The application of glucocorticoids in TKA implied a beneficial trend in analgesic, anti-inflammatory, and antiemetic effects, as well as improved range of motion and shortened hospital stay. While it will not increase the risk of continued high glucose, postoperative wound infection and venous thrombosis.
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Affiliation(s)
- Fangyan Liu
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Mei Duan
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Huiqun Fu
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.
- National Clinical Research Center for Geriatric Diseases, Beijing, China.
- Beijing Institute for Brain Disorders, Beijing, China.
- Center for Sleep and Consciousness Disorders, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.
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Liu L, Li J, Wang Y, Li X, Han P, Li X. Different modalities of patellar management in primary total knee arthroplasty: a Bayesian network meta-analysis of randomized controlled trials. J Orthop Surg Res 2024; 19:74. [PMID: 38233873 DOI: 10.1186/s13018-024-04546-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The primary management modalities for the patella in TKA include patellar resurfacing, patellar non-resurfacing, patellar resurfacing with denervation, and patellar non-resurfacing with denervation. Traditionally, meta-analyses have predominantly focused on examining comparisons between two management modalities. However, this study performed a network meta-analysis to compare all four patellar management interventions to identify the most optimal approach for patellar management in TKA. METHODS A computer-based search of PubMed, China National Knowledge Infrastructure (CNKI), The Cochrane Library, Web of science, Embase, and MEDLINE databases was performed to identify randomized controlled trials focusing on the four management interventions for the patella in TKA. Comparisons included two-by-two comparisons as well as those involving more than two concurrent comparisons. The search timeframe spanned from inception to June 30, 2023. Two independent authors extracted the data and evaluated the quality of the literature. The Cochrane Collaboration Risk of Bias (ROB) tool was used to evaluate the overall quality of the literature. Subsequently, a network meta-analysis was conducted using the "gemtc" package of the R-4.2.3 software. Outcome measures such as anterior knee pain (AKP), reoperation rate, and patient satisfaction rate were evaluated using odd ratio (OR) and 95% confidence intervals (CI). Additionally, the knee society score (KSS), function score (FS), and range of motion (ROM) were evaluated using mean differences (MD) with associated 95% CI. The different treatment measures were ranked using the surfaces under the cumulative ranking curves (SUCRA). RESULTS A total of 50 randomized controlled trials involving 9,283 patients were included in the analysis. The findings from this network meta-analysis revealed that patellar resurfacing exhibited significantly lower postoperative reoperation rate (OR 0.44, 95% CI 0.24-0.63) and AKP (OR 0.58, 95% CI 0.32-1) compared to non-resurfacing. Additionally, patellar resurfacing exhibited higher postoperative KSS clinical scores in comparison with non-resurfacing (MD: 1.13, 95% CI 0.18-2.11). However, for postoperative FS, ROM, and patient satisfaction, no significant differences were observed among the four management interventions. CONCLUSION Patellar resurfacing emerges as the optimal management modality in primary TKA. However, future studies should aim to reduce sources of heterogeneity and minimize the influence of confounding factors on outcomes. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023434418 identifier: CRD42023434418.
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Affiliation(s)
- Lun Liu
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, No. 83, Heping West Street, Changzhi, 046000, Shanxi, China
- Graduate School, Changzhi Medical College, No. 161, Jiefang East Street, Changzhi, 046000, Shanxi, China
| | - Juebei Li
- Graduate School, Huazhong University of Science and Technology, No. 13, Hangkong Road, Wuhan, 430000, Hubei, China
| | - Yunlu Wang
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, No. 83, Heping West Street, Changzhi, 046000, Shanxi, China
- Graduate School, Changzhi Medical College, No. 161, Jiefang East Street, Changzhi, 046000, Shanxi, China
| | - Xiyong Li
- Graduate School, Changzhi Medical College, No. 161, Jiefang East Street, Changzhi, 046000, Shanxi, China
- Department of Orthopaedics, Heping Hospital Affiliated To Changzhi Medical College, No. 110, Yan'an South Road, Changzhi, 046000, Shanxi, China
| | - Pengfei Han
- Department of Orthopaedics, Heping Hospital Affiliated To Changzhi Medical College, No. 110, Yan'an South Road, Changzhi, 046000, Shanxi, China.
| | - Xiaodong Li
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, No. 83, Heping West Street, Changzhi, 046000, Shanxi, China.
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McConaghy K, Derr T, Molloy RM, Klika AK, Kurtz S, Piuzzi NS. Patellar management during total knee arthroplasty: a review. EFORT Open Rev 2021; 6:861-871. [PMID: 34760286 PMCID: PMC8559560 DOI: 10.1302/2058-5241.6.200156] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The optimal management of the patella during total knee arthroplasty (TKA) remains controversial and surgeons tend to approach the patella with one of three general mindsets: always resurface the patella, never resurface the patella, or selectively resurface the patella based on specific patient or patellar criteria. Studies comparing resurfacing and non-resurfacing of the patella during TKA have reported inconsistent and contradictory findings. When resurfacing the patella is chosen, there are a number of available patellar component designs, materials, and techniques for cutting and fixation. When patellar non-resurfacing is chosen, several alternatives are available, including patellar denervation, lateral retinacular release, and patelloplasty. Surgeons may choose to perform any of these alone, or together in some combination. Prospective randomized studies are needed to better understand which patellar management techniques contribute to superior postoperative outcomes. Until then, this remains a controversial topic, and options for patellar management will need to be weighed on an individual basis per patient.
Cite this article: EFORT Open Rev 2021;6:861-871. DOI: 10.1302/2058-5241.6.200156
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Affiliation(s)
- Kara McConaghy
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Tabitha Derr
- Implant Research Core, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Robert M Molloy
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA
| | - Alison K Klika
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA
| | - Steven Kurtz
- Implant Research Core, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA.,Exponent, Philadelphia, Pennsylvania, USA
| | - Nicolas S Piuzzi
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA
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Deekshith SRK, Reddy KJ, Raviteja R. RETRACTED ARTICLE: Patelloplasty in total knee arthroplasty with circumpatellar denervation versus without denervation - a randomized prospective study. ARTHROPLASTY 2020; 2:26. [PMID: 35236444 PMCID: PMC8796643 DOI: 10.1186/s42836-020-00044-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 08/03/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Anterior knee pain is one of the major problems in total knee arthroplasty (TKA) and is often etiologically associated with a patellofemoral parts etiology. There is no consensus as to etiology or treatment. Denervation of the patella by electrocautery and patelloplasty along with removal of osteophytes have been used for treatment of anterior knee pain in TKA. The purpose of our study was to compare, in terms of the anterior knee pain and clinical outcomes of patelloplasty in total knee arthroplasty (TKA), patellar denervation by electrocautery and non-patellar-denervation treatment in a 2 year follow-up. MATERIALS AND METHODS This study was conducted in a total of 108 patients, who underwent TKA at our institution between June 2015 and December 2016. Patients age 55 to 80 years, who are suffering from osteoarthritis, rheumatoid arthritis of knee were included in this study. Patients were randomly allocated into patelloplasty with denervation group and non-denervation group. The denervation of the patella was done in electrocautery group using a monopolar coagulation diathermy set to 50 W. (Valleylab Inc., Boulder, CO). Postoperatively, patients were assessed at regular intervals of 3, 6, 9, 12, 24 months. To assess patient outcomes, we used questionnaires to determine the Knee Society score (KSS - knee and function scores), a specific patellofemoral pain questionnaire (Kujala score) range of motion (ROM) and a visual analogue scale (VAS) to assess anterior knee pain. RESULTS The data obtained were analyzed using SPSS version 17.0. Continuous variables were expressed as mean ± SD. Of the 108 patients, 9 patients were lost to follow-up. Among the remaining 99 patients, 50 were included in denervation group and 49 in non-denervation group. In our study, there was no statistically significant difference in Mean KUJALA score preoperatively (p > 0.05). Postoperatively, the mean KUJALA score was significantly higher in denervation group at 3, 6, 9, 12, 24 months of follow-up when compared to TKR with no denervation (p < 0.05). There was no statistically significant difference in Mean VAS score preoperatively (p > 0.05). However, 6, 12 and 24 months after the operation, the mean VAS score was significantly lower in denervation group. There was no statistically significant difference in Mean KSS score preoperatively and postoperatively (p > 0.05). The mean ROM was significantly higher in denervation group than in the group of TKR with no denervation (p < 0.05). CONCLUSION In our study, less postoperative anterior knee pain, increased range of motion, significantly lower VAS scores were seen in the denervation group compared with non-denervation group. Circumferential denervation of patella during primary TKA along with patellar resurfacing is a safe procedure that improves patient satisfaction, decreases anterior knee pain and improves range of flexion in the postoperative period and at postoperative follow-ups.
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Affiliation(s)
- S. R. K. Deekshith
- Department of Orthopedics, SVS Medical College and Hospital, Mahabubnagar, Telangana State 500062 India
| | - K. J. Reddy
- Department of Orthopedics, SVS Medical College and Hospital, Mahabubnagar, Telangana State 500062 India
| | - R. Raviteja
- Department of Orthopedics, SVS Medical College and Hospital, Mahabubnagar, Telangana State 500062 India
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Klem NR, Kent P, Smith A, Dowsey M, Fary R, Schütze R, O'Sullivan P, Choong P, Bunzli S. Satisfaction after total knee replacement for osteoarthritis is usually high, but what are we measuring? A systematic review. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100032. [DOI: 10.1016/j.ocarto.2020.100032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/20/2020] [Indexed: 12/17/2022] Open
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Antinolfi P, Manfreda F, Placella G, Teodori J, Cerulli G, Caraffa A. The Challenge of Managing the "Third-Space" in Total Knee Arthroplasty: Review of Current Concepts. JOINTS 2018; 6:204-210. [PMID: 30582109 PMCID: PMC6301849 DOI: 10.1055/s-0038-1675845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 10/07/2018] [Indexed: 12/17/2022]
Abstract
Total knee arthroplasty (TKA) is the best treatment for advanced knee osteoarthritis and it has proven to be durable and effective. Anterior knee pain (AKP) is still one of the most frequent complications after TKA, but sometimes no recognized macroscopic causes can be found. The correct treatment of patella is considered the key for a proper management of AKP. The inclusion of patellar resurfacing during TKA has been described as a potential method for the reduction of AKP. After surgeons started to resurface the patella, new complications emerged, such as component failure, instability, fracture, tendon rupture, and soft tissue impingement. Patelloplasty has been proposed as a good alternative to resurfacing but whether or not to resurface the patella is still a controversial topic in the literature. Therefore, patellofemoral joint is a complex critical aspect in TKA and choosing between the several options of treatment of patella could not be sufficient. In this review, evidence-based studies do not succeed in resolving this difficult argument. The accurate management of the so-called “third space” should include an accurate assessment of cartilage layers, balance of soft tissue, preoperative anterior tracking, and positioning of the femoral and tibial components. In fact, the selection of suitable implants and adherence to proper surgical technique are the fundamental principles for the success of TKA.
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Affiliation(s)
- Pierluigi Antinolfi
- Service of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Francesco Manfreda
- Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy
| | - Giacomo Placella
- Service of Orthopedics and Traumatology, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - Julien Teodori
- Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy
| | - Giuliano Cerulli
- I.R.T.A.L. Istituto di Ricerca Traslazionale Apparato Locomotore, Nicola's Foundation, Arezzo, Italy
| | - Auro Caraffa
- Service of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy.,Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy
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Duan G, Liu C, Lin W, Shao J, Fu K, Niu Y, Wang F. Different Factors Conduct Anterior Knee Pain Following Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2018; 33:1962-1971.e3. [PMID: 29398258 DOI: 10.1016/j.arth.2017.12.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/30/2017] [Accepted: 12/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A systematic review and meta-analysis was performed to investigate the risks associated with anterior knee pain (AKP) following primary total knee arthroplasty (TKA). METHODS A computerized search was performed of the following databases: MEDLINE, Embase, and Cochrane Central (published prior to July 2017). A total of 37 studies, which included 1641 cases of AKP and 168,090 TKAs, were included in the meta-analysis. RESULTS A subgroup analysis revealed that compared with those without the following medical conditions, patients who had an infrapatellar fat pad excision and more than 12 months of follow-up (odds ratio [OR] 12.58, 95% confidence interval [CI] 3.245-48.781) were more likely to have AKP after TKA. Circumpatellar electrocautery (>12 months: OR 0.50, 95% CI 0.326-0.760; ≤12 months: OR 0.59, 95% CI 0.408-0.867) and patellar resurfacing (OR 0.25, 95% CI 0.131-0.485) may decrease the risk of AKP. Other factors, including the prosthesis bearing type (mobile bearing or fixed bearing) and the approach (midvastus compared with the medial parapatellar approach), were not significant risk factors for AKP. CONCLUSION The use of strategies such as patellar denervation and patellar resurfacing in primary TKA is recommended because they are safe and result in good clinical outcomes in preventing AKP. Caution should be taken when using an infrapatellar fat pad excision, because there is an increased risk of AKP at long-term follow-up (>12 months). Future studies should investigate these different strategies to confirm the underlying mechanisms and help prevent the occurrence of AKP after TKA. The timing of AKP onset remains unclear and requires further research.
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Affiliation(s)
- Guman Duan
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Chang Liu
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Weiwei Lin
- Department of Neurosurgery, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Jiashen Shao
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Kunpeng Fu
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yingzhen Niu
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Fei Wang
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
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The efficacy and safety of dexamethasone for pain management after total knee arthroplasty: A systematic review and meta-analysis. Int J Surg 2018; 53:65-71. [DOI: 10.1016/j.ijsu.2018.03.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/04/2018] [Accepted: 03/13/2018] [Indexed: 11/18/2022]
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Cerciello S, Robin J, Lustig S, Maccauro G, Heyse TJ, Neyret P. The role of patelloplasty in total knee arthroplasty. Arch Orthop Trauma Surg 2016; 136:1607-1613. [PMID: 27687176 DOI: 10.1007/s00402-016-2577-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Anterior knee pain (AKP) is a frequent complication after total knee arthroplasty (TKA). Patelloplasty, defined as reshaping the patella for optimal tracking in the trochlea, has been proposed to reduce the rate of this complication in patellar retaining implants. Aim of this study was to analyze the available literature regarding the outcomes of patelloplasty and to assess its methodological quality. MATERIALS AND METHODS A comprehensive review of the English literature was performed using the keywords "total knee arthroplasty", "patelloplasty" and "patellaplasty" with no limit regarding the year of publication. All the selected articles were evaluated with the Coleman score. RESULTS Seven full text articles were retrieved. The initial cohort included 461 knees in the study groups and 465 in the control groups. At an average FU of 70.6 months 447 knees were reviewed in the study group and 447 in the control groups. The global rate of AKP after patelloplasty was 11.3 % which compared to 7.9 % in the patella resurfacing control group. No signs of specific patellar complications due to patelloplasty were reported. Average Coleman score was 66.9. CONCLUSION Most of the literature has barely sufficient methodological quality. Patelloplasty aims at reducing patellar thickness and improve its tracking with TKA. This procedure is a safe and easy option with no reported adverse effects. In the included studies, outcome seemed to be superior in comparison with isolated osteophyte removal and denervation with a lower rate of AKP. The included studies, however, report a lower rate of AKP following TKA with patellar resurfacing. Patelloplasty may have the potential to improve the outcome of patellar retaining implants. LEVEL OF EVIDENCE 4, systematic review.
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Affiliation(s)
- Simone Cerciello
- Casa di Cura Villa Betania, Via Piccolomini 27, 00165, Rome, Italy. .,Marrelli Hospital, Via Gioacchino da Fiore, 0962, Crotone, Italy.
| | - Jonathan Robin
- Albert Trillat Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Sébastien Lustig
- Albert Trillat Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Giulio Maccauro
- Department of Geriatric Neurosciences and Orthopaedics, Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Thomas J Heyse
- Center for Orthopaedics and Trauma Surgery, University Hospital, Baldingerstrasse, 35043, Marburg, Germany
| | - Philippe Neyret
- Albert Trillat Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
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Keshmiri A, Maderbacher G, Baier C, Müller W, Grifka J, Springorum HR. Do surgical patellar interventions restore patellar kinematics in fixed-bearing, cruciate-retaining total knee arthroplasty?: An in vitro study. J Arthroplasty 2014; 29:2197-201. [PMID: 25108734 DOI: 10.1016/j.arth.2014.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/20/2014] [Accepted: 07/07/2014] [Indexed: 02/01/2023] Open
Abstract
Despite different surgical patellar interventions, the decision how to treat the patella during TKA remains controversial. The purpose of this study was to quantify the effect of different reconstructive patellar interventions on patellar kinematics during TKA using optical computer navigation. We implanted ten navigated TKAs in full body specimens. During passive motion, the effect of different surgical patellar interventions on patellar kinematics was analysed. A contrarily tilt behaviour was observed in the TKA group without patellar intervention compared to the natural knee. Lateral release led to similar tilt values (P < 0.05). All surgical interventions led to a 3 to 5mm medial shift of the patella (P < 0.05). None of the analysed surgical patellar interventions could restore natural patellar kinematics after TKA.
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Affiliation(s)
- Armin Keshmiri
- Department of Orthopaedic Surgery, University of Regensburg, Bad Abbach, Germany
| | - Günther Maderbacher
- Department of Orthopaedic Surgery, University of Regensburg, Bad Abbach, Germany
| | - Clemens Baier
- Department of Orthopaedic Surgery, University of Regensburg, Bad Abbach, Germany
| | - Werner Müller
- Department of Orthopaedic Surgery, Cantonal Hospital Bruderholz, Bruderholz, Swiss
| | - Joachim Grifka
- Department of Orthopaedic Surgery, University of Regensburg, Bad Abbach, Germany
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Cheng T, Zhu C, Guo Y, Shi S, Chen D, Zhang X. Patellar denervation with electrocautery in total knee arthroplasty without patellar resurfacing: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2014; 22:2648-54. [PMID: 23743580 DOI: 10.1007/s00167-013-2533-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 05/13/2013] [Indexed: 02/09/2023]
Abstract
PURPOSE The impact of patellar denervation with electrocautery in total knee arthroplasty (TKA) on post-operative outcomes has been under debate. This study aims to conduct a meta-analysis and systematic review to compare the benefits and risks of circumpatellar electrocautery with those of non-electrocautery in primary TKAs. METHODS Comparative and randomized clinical studies were identified by conducting an electronic search of articles dated up to September 2012 in PubMed, EMBASE, Scopus, and the Cochrane databases. Six studies that focus on a total of 849 knees were analysed. A random-effects model was conducted using the inverse-variance method for continuous variables and the Mantel-Haenszel method for dichotomous variables. RESULTS There was no significant difference in the incidence of anterior knee pain between the electrocautery and non-electrocautery groups. In term of patellar score and Knee Society Score, circumpatellar electrocautery improved clinical outcomes compared with non-electrocautery in TKAs. The statistical differences were in favour of the electrocautery group but have minimal clinical significance. In addition, the overall complications indicate no statistical significance between the two groups. CONCLUSIONS This study shows no strong evidence either for or against electrocautery compared with non-electrocautery in TKAs. LEVEL OF EVIDENCE Therapeutic study (systematic review and meta-analysis), Level III.
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Affiliation(s)
- Tao Cheng
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China,
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Better results with patelloplasty compared to traditional total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2014; 38:1621-5. [PMID: 24848970 DOI: 10.1007/s00264-014-2366-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to compare the results of primary total knee arthroplasty with or without patelloplasty. METHODS We retrospectively reviewed 89 patients who had received total knee arthroplasty. In patelloplasty, the patellar cartilage was resected using a tangential saw cut, and in the traditional treatment, only the surrounding osteophytes were removed. The outcome was measured using radiographs, Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score, Knee Society Score, Knee Society Function Score and Knee Society Pain Score. RESULTS Patelloplasty patients had a better outcome according to the Oxford Knee Score (P = 0.012), Knee Injury and Osteoarthritis Outcome Score (P = 0.003) and all of the Knee Injury and Osteoarthritis Outcome Score subscales (P < 0.05). The patella was significantly thinner (P = 0.001) post-operatively in the patelloplasty patients, but there was no statistically significant correlation between Oxford Knee Score or Knee Injury and Osteoarthritis Outcome Score and post-operative patellar thickness in the patelloplasty group. CONCLUSIONS In this follow-up, patelloplasty was better than traditional treatment in relieving pain and improving function and quality of life.
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