Influence of patellar denervation on anterior knee pain and knee function following total knee replacement: a systematic review and meta‐analysis

Yu, Qin; Pu, Chuancheng; Zhou, Yong; Jiang, Yu

doi:10.1111/ans.17078

Cited by 7 publications

(9 citation statements)

References 32 publications

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“…The median values of OKS, WOMAC as well as KOOS Symptoms and Pain components of the present study were all within the 4th quartile (within the upper 75–100%) of mean values reported in recent systematic reviews and/or meta‐analyses on TKA [10, 12, 14, 15, 23, 24, 26, 27, 29, 30, 38, 41–44]. The median values of FJS as well as the ADL, Function and QOL components for KOOS were all within the 3rd quartile (within the upper 50–75%) of mean values reported in recent systematic reviews and/or meta‐analyses on TKA (Fig.…”

Section: Resultssupporting

confidence: 76%

“…Comparison of patient‐reported outcome measures (PROMs) to pooled results in systematic reviews and/or meta‐analyses on OTS TKA. Footnotes: 1 Rudran et al [41] (5 studies); Elbardesy et al [14] (4 studies); Li et al [27] (2 studies); Qin et al [38] (3 studies); Tso et al [43]; Deng et al [12] (3 studies); Gao et al [15] (4 studies); Kim et al [24] (2 studies); Luo et al [29] (4 studies). 2 Tso et al [43] (5 studies); Cacciola et al [10] (2 studies); Luo et al [29] (2 studies).…”

Section: Resultsmentioning

confidence: 99%

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Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years

Gousopoulos

Dobbelaere

Ratano

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose was to report detailed patient-reported outcome measures (PROMs) and satisfaction rates for computed tomography (CT)-based custom TKA at minimum follow-up of 2 years. The hypothesis was that custom TKA combined with 'personalised alignment' would yield equivalent or better PROMs compared to values reported in systematic reviews and meta-analyses on of-the-shelf (OTS) TKA. Methods Of an initial cohort of 150 custom TKAs, four died (unrelated to surgery), one required a revision, and ive refused participation, leaving 140 patients for analysis. Patients completed pre-and post-operative PROMs (Oxford Knee Score (OKS), Forgotten Joint Score (FJS), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster osteoarthritis index (WOMAC)) as well as overall level of satisfaction. Proportions that attained a patient acceptable symptom state (PASS) were calculated for OKS and FJS. Clinical indings were compared to the average scores reported for PROMs in recent systematic reviews and/or meta-analyses on OTS TKA. Descriptive statistics were used to summarise the clinical indings as means, standard deviations (SD) and ranges, or numbers and percentages. Results At mean follow-up 33.5 ± 4.5 months, 94% (135/143) were either satisied or very satisied. Proportions that achieved PASS were 89% for OKS (120/135), and 85% for FJS (118/139). Median OKS, WOMAC and KOOS Symptoms and Pain scores were all within the 4th quartile of medians reported in systematic reviews and/or meta-analyses. Conclusions At a minimum follow-up of two years following custom TKA combined with 'personalised alignment', 94% of patients were either satisied or very satisied, and the PASS criteria were achieved in 89% for OKS and 85% for FJS, all of which compare favourably to published outcomes of OTS TKA. Direct comparisons to the literature may not be appropriate, however, considering the heterogeneity of patient demographics and alignment techniques. Randomised controlled trials with suicient statistical power are needed to corroborate these indings and generalise them to unselected TKA patients. Level of evidence IV, retrospective cohort study.

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Section: Resultssupporting

confidence: 76%

Section: Resultsmentioning

confidence: 99%

Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years

Gousopoulos

Dobbelaere

Ratano

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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“…Patellar denervation is an electrocautery technique demonstrated to significantly reduce rates of anterior knee pain in tKa for both resurfaced and unresurfaced knees by recent meta-analyses. [64][65][66][67] Patellar denervation was used in five studies included in this meta-analysis, either in both groups or just the unresurfaced knees. 30,31,37,40,44 Patelloplasty is a vaguely defined intervention that aims at reshaping the patella for optimal articular tracking in the trochlea and is often used instead of patellar resurfacing in unresurfaced patellae.…”

Section: Discussionmentioning

confidence: 99%

Patellar resurfacing versus retention in cruciate-retaining and posterior-stabilized total knee arthroplasty

Simpson

Wright

et al. 2023

Bone Joint J

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AimsThis systematic review and meta-analysis aimed to compare the influence of patellar resurfacing following cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA) on the incidence of anterior knee pain, knee-specific patient-reported outcome measures, complication rates, and reoperation rates.MethodsA systematic review of MEDLINE, PubMed, and Google Scholar was performed to identify randomized controlled trials (RCTs) according to search criteria. Search terms used included: arthroplasty, replacement, knee (Mesh), TKA, prosthesis, patella, patellar resurfacing, and patellar retaining. RCTs that compared patellar resurfacing versus unresurfaced in primary TKA were included for further analysis. Studies were evaluated using the Scottish Intercollegiate Guidelines Network assessment tool for quality and minimization of bias. Data were synthesized and meta-analysis performed.ResultsThere were 4,135 TKAs (2,068 resurfaced and 2,027 unresurfaced) identified in 35 separate cohorts from 33 peer-reviewed studies. Anterior knee pain rates were significantly higher in unresurfaced knees overall (odds ratio (OR) 1.84; 95% confidence interval (CI) 1.20 to 2.83; p = 0.006) but more specifically associated with CR implants (OR 1.95; 95% CI 1.0 to 3.52; p = 0.030). There was a significantly better Knee Society function score (mean difference (MD) -1.98; 95% CI -1.1 to -2.84; p < 0.001) and Oxford Knee Score (MD -2.24; 95% CI -0.07 to -4.41; p = 0.040) for PS implants when patellar resurfacing was performed, but these differences did not exceed the minimal clinically important difference for these scores. There were no significant differences in complication rates or infection rates according to implant design. There was an overall significantly higher reoperation rate for unresurfaced TKA (OR 1.46 (95% CI 1.04 to 2.06); p = 0.030) but there was no difference between PS or CR TKA.ConclusionPatellar resurfacing, when performed with CR implants, resulted in lower rates of anterior knee pain and, when used with a PS implant, yielded better knee-specific functional outcomes. Patellar resurfacing was associated with a lower risk of reoperation overall, but implant type did not influence this.Cite this article: Bone Joint J 2023;105-B(6):622–634.

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“…Therefore, PD with electrocautery has the theoretical advantage of reducing the occurrence of postoperative AKP by regulating these pain receptors. Several studies have demonstrated that PD effectively improves AKP after TKA without resurfacing the patella [27, 35, 40, 42]. However, the evidence on PD for pain reduction is conflicting.…”

Section: Discussionmentioning

confidence: 99%

Preoperative patellar bone marrow lesions with full thickness cartilage defects correlate with residual anterior knee pain in total knee arthroplasty without patellar resurfacing

Jung Jung,

Kang,

Lee

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Residual anterior knee pain is one of the most common problems after total knee arthroplasty (TKA). However, the contributing factors afecting postoperative anterior knee pain (AKP) remain poorly understood. This study aimed to evaluate the efect of preoperative patellar bone marrow lesions (BMLs) and patellar cartilage defects on postoperative AKP after patellar non-resurfacing TKA. Methods This retrospective study included 336 patients who underwent unilateral TKA without patella resurfacing. All patients underwent preoperative magnetic resonance imaging (MRI) to assess the presence of BMLs and the degree of cartilage defects in the patella. Patients were categorized into four groups according to the presence of BMLs (with or without BMLs) and the degree of cartilage defects (with or without full thickness cartilage defects). The Kujala Anterior Knee Pain Scale (AKPS) and the Hospital for Special Surgery Knee Rating Scale (HSS) scores at 2 years after TKA were compared among the groups. Results Preoperative BMLs in the patella were found in 132 (39.3%) of 336 cases. Among the four groups, the group with both BMLs and full-thickness cartilage defects demonstrated signiicantly lower AKPS compared to the other groups at 2 years after TKA (p < 0.01), but no signiicant diference was shown in the HSS scores, between these groups. There were no signiicant diferences in either AKPS or HSS scores among the other three patient groups. Conclusions The presence of preoperative BMLs with full-thickness cartilage defects in the patella was associated with worse postoperative AKP after TKA without patella resurfacing. Patella resurfacing should be considered in this patient group to minimize the risk of developing residual AKP after TKA. Level of evidence III.

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Influence of patellar denervation on anterior knee pain and knee function following total knee replacement: a systematic review and meta‐analysis

Cited by 7 publications

References 32 publications

Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years

Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years

Patellar resurfacing versus retention in cruciate-retaining and posterior-stabilized total knee arthroplasty

Preoperative patellar bone marrow lesions with full thickness cartilage defects correlate with residual anterior knee pain in total knee arthroplasty without patellar resurfacing

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