Patellar denervation does not reduce post-operative anterior knee pain after primary total knee arthroplasty with patellar resurfacing

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 efects have not been assessed in combination with patellar resurfacing. The aim of this study is to evaluate the efect 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/m 2 (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 diferences 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 diference 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.

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

“…Two pioneer studies published in 2020 and 2021 investigated the PD in patella resurfacing TKR and were included in our study. 18,19 Our data proved that PD knees with patella resurfacing and patella non-resurfacing both have lower AKP incidence when compared to NPD knees, and PD is preferred in patella resurfacing TKR.…”

“…S1). [8][9][10][11][16][17][18][19][24][25][26][27][28] Characteristics and quality of trials the NPD group. The characteristics of included trials and details of TKR procedure are presented in Table S1.…”

“…[12][13][14][15] The most recent meta-analysis published by Wang et al only included nine RCTs, and concluded that PD could reduce the prevalence of AKP as well as improve knee function in the early stage following TKR. 15 It is worth mentioning that several RCTs with high quality has been published recently, [16][17][18][19] and were not included and evaluated in previous meta-analyses. Therefore, we performed this systematic review and meta-analysis to re-evaluate the effects of PD on AKP and knee function after TKR.…”

Patellar management during total knee arthroplasty: a review

“…Several studies have shown equivalent clinical results with or without circumpatellar electrocautery. 132 – 135 In the most recent of these studies, Goicoechea et al found no significant difference in anterior knee pain or knee function scores in primary TKA with patellar resurfacing compared to patellar replacement without denervation. 135 Therefore, based on current results, patellar denervation cannot be recommended when patellar resurfacing is performed in TKA.…”

“… 135 Therefore, based on current results, patellar denervation cannot be recommended when patellar resurfacing is performed in TKA. 135 …”