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

Zhang, Peng; Líu, Hao; Yan, Wenshan; Wang, Wenliang

doi:10.1007/s00167-015-3811-5

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…Several previous meta‐analyses comparing PD and non‐PD in TKA without patellar resurfacing showed discordant results; one of them concluded PD had no clear advantage over non‐PD 35 while others found PD can provide superior postoperative clinical results 16,36,37 . One meta‐analysis performed by Xie et al 17 .…”

Section: Discussionmentioning

confidence: 99%

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Patellar Denervation with Electrocautery Reduces Anterior Knee Pain within 1 Year after Total Knee Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

Yuan

Ding

Ling

et al. 2020

Orthopaedic Surgery

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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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Section: Discussionmentioning

confidence: 99%

“…The literature search in the most recently published meta‐analysis on this topic by Zhang et al 16 . was conducted in February 2015.…”

Section: Introductionmentioning

confidence: 99%

Patellar Denervation with Electrocautery Reduces Anterior Knee Pain within 1 Year after Total Knee Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

Yuan

Ding

Ling

et al. 2020

Orthopaedic Surgery

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“…[2][3][4][5] As a common cause of failure of TKR, AKP can cause persistent knee pain, limit knee function, result in patient dissatisfaction and even revision. 6 Great effort has been made to reduce the incidence of AKP following TKR, and techniques such as circumferential patellar denervation with electrocautery (PD), patella resurfacing and infrapatellar fat pad excision have been developed.…”

Section: Introductionmentioning

confidence: 99%

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

Zhou

et al. 2021

ANZ Journal of Surgery

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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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“…Since 2015, two studies have demonstrated significantly improved anterior knee pain and functional outcomes in patients who received circumpatellar electrocautery. 125 , 126 However, some studies have suggested that these improvements may not be lasting. 123 , 127 , 128 While Motififard et al found a statistically significant improvement in postoperative anterior knee pain following patellar denervation at three-week follow-up, this effect disappeared by the three-month follow-up.…”

Section: Patellar Non-resurfacing Managementmentioning

confidence: 99%

Patellar management during total knee arthroplasty: a review

et al. 2021

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

Abstract: Therapeutic study, Level II.

Cited by 9 publications

References 29 publications

Patellar Denervation with Electrocautery Reduces Anterior Knee Pain within 1 Year after Total Knee Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

Patellar Denervation with Electrocautery Reduces Anterior Knee Pain within 1 Year after Total Knee Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

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

Patellar management during total knee arthroplasty: a review

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