Does circumpatellar electrocautery improve the outcome after total knee replacement?

Abstract

The incidence of anterior knee pain following total knee replacement (TKR) is reported to be as high as 49%. The source of the pain is poorly understood but the soft tissues around the patella have been implicated. In theory circumferential electrocautery denervates the patella thereby reducing efferent pain signals. However, there is mixed evidence that this practice translates into improved outcomes. We aimed to investigate the clinical effect of intra-operative circumpatellar electrocautery in patients undergoing TKR using the LCS mobile bearing or Kinemax fixed bearing TKR. A total of 200 patients were randomised to receive either circumpatellar electrocautery (diathermy) or not (control). Patients were assessed by visual analogue scale (VAS) for anterior knee pain and Oxford knee score (OKS) pre-operatively and three months, six months and one year post-operatively. Patients and assessors were blinded. There were 91 patients in the diathermy group and 94 in the control. The mean VAS improvement at one year was 3.9 in both groups (control; -10 to 6, diathermy; -9 to 8, p < 0.001 in both cases, paired, two-tailed t-test). There was no significant difference in VAS between the groups at any other time. The mean OKS improvement was 17.7 points (0 to 34) in the intervention group and 16.6 (0 to 42) points in the control (p = 0.36). There was no significant difference between the two groups in OKS at any other time. We found no relevant effect of patellar electrocautery on either VAS anterior knee pain or OKS for patients undergoing LCS and Kinemax TKR.

Patellofemoral resurfacing and patellar denervation in primary total knee arthroplasty

“…However, some authors report that a non-resurfaced patella may be associated with a higher rate of anterior knee pain [4].…”

Is patellar denervation necessary in total knee arthroplasty without patellar resurfacing?

“…A large number of patients could increase the reliability of meta-analysis. Secondly, the risk factors were inconsistent in above RCTs [1,4,[19][20][21]28]. For example, female gender, ages, days of follow-up and depth of circumpatellar electrocautery were considered as risk factors.…”

“…Among the six included trials [1,4,[19][20][21]28], random sequence generation which means a low risk of bias was clearly conducted and introduced in three studies [4,19,21]. The other three studies [1,20,28] did not describe the exact method of randomization in spite of simple description in title.…”

“…Similarly, all studies reported outcomes they planed previously, suggesting a low risk of bias. Five studies reported that they did not receive any commercial funding or grants in support of their research [1,[19][20][21]28], whereas one study received financial grants from commercial supports [4]. No other apparent bias was found among the included studies.…”

“…These results remained controversial. Among them, three prospective studies [4,21,28] show no evidence…”