Patellar Resurfacing Versus Circumferential Denervation of the Patella in Total Knee Arthroplasty

Spencer, Brian A.; Cherian, Jeffrey J.; Margetas, George; Chughtai, Morad; Harwin, Steven F.; Elmallah, Randa K.; Mont, Michael A.

doi:10.3928/01477447-20160623-14

Cited by 14 publications

(10 citation statements)

References 23 publications

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“…However, according to the results of a recent study 17 , the efficacy of patellar resurfacing is imprecise. A study comparing patellar resurfacing and PD showed that there is no significant difference in the incidence of AKP with a 2-year FU 18 . As patellar resurfacing could result in several complications, such as fracture, loosening, and dislocation 19,20 , many surgeons prefer to not perform patellar resurfacing in TKA.…”

Section: Discussionmentioning

confidence: 99%

Effect of Patellar Denervation on Anterior Knee Pain and Knee Function in Total Knee Arthroplasty without Patellar Resurfacing: A Meta‐Analysis of Randomized Controlled Trials

Wang

Feng

Zang

et al. 2020

Orthopaedic Surgery

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The aim of the present study was to evaluate the effect of patellar denervation (PD) in preventing anterior knee pain (AKP) and improving knee function after total knee arthroplasty (TKA) without patellar resurfacing, and to help surgeons decide whether or not to use PD in TKA. Methods: The electronic databases of Pubmed, Embase, Cochrane, Web of Science, and Scopus were searched for all randomized controlled trials (RCT) comparing the outcomes of PD and no patellar denervation (NPD) in TKA without patellar resurfacing. Primary outcomes were incidence of AKP, visual analogue scale for pain (VAS), and patellar score (PS). Secondary outcomes were Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Knee Score (OKS), knee range of motion (ROM), and complications. Results: A total of nine RCT met the inclusion criteria. On meta-analysis, PD significantly reduced the incidence of AKP (odds ratio 0.49; 95% confidence interval [CI] 0.26 to 0.92), reduced the VAS (weighted mean difference [WMD] −0.57; 95% CI −1.02 to −0.11), and improved the WOMAC (WMD −4.63; 95% CI −6.49 to −2.77) and the ROM (WMD 9.60; 95% CI 0.39 to 18.81) during the follow-up within 12 months. In addition, PD improved the PS (WMD 1.01; 95% CI 0.65 to 1.38), KSS (WMD 1.12; 95% CI 0.10 to 2.14), and the WOMAC (WMD −1.41; 95% CI −2.74 to −0.08) during the follow-up after 12 months. Conclusion: Patellar denervation could significantly reduce the VAS and the incidence of AKP in the early stages after TKA as well as improve the clinical outcomes in terms of the PS, the WOMAC, the KSS, and the ROM. This study demonstrates that PD is a safe and recommendable technique that could be routinely performed in TKA.

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Section: Discussionmentioning

confidence: 99%

Effect of Patellar Denervation on Anterior Knee Pain and Knee Function in Total Knee Arthroplasty without Patellar Resurfacing: A Meta‐Analysis of Randomized Controlled Trials

Wang

Feng

Zang

et al. 2020

Orthopaedic Surgery

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“…VAS) before TKA, with non significant statistical difference between them. After 3 months of the operation, both groups were showing a slight decrease in VAS compared with that before TKA, with a non-significant statistical difference between them.This is due to the fact that in early period after TKA, the wound healing is notcomplete, leading to the slight VAS changes andthe non-significant difference between both study groups.It is worthwhile here to emphasize on wound healing problems which should be avoided during this period with the special and aggressive care, as the minimal incision infection can turn into a major complication (12). After 6 months of TKA, significant statistical difference (P< 0.05) was seen, and group (1) patients were more satisfied with progressive pain decrease.…”

Section: Figure (2): Total Knee Arthroplasty With Patellar Denervationmentioning

confidence: 97%

Comparative study of anterior knee pain after patelloplasty with and without circumferential denervation in a total knee arthroplasty

Al-Shamari¹

2019

Al-Kindy Col. Med. J

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Background: The anterior knee pain is an important chief complaint of the patients with knee osteoarthritis due to patellofemoral pathology. The pain receptors denervation can be achieved by circumferential denervation of the patellar area by a process of electrocautery. Objectives: The aim of current study is to assess the pain after total knee arthroplasty (TKA) by patelloplastywith and without circumferential denervation via electrocautery at a minimum follow up with 1 year separately for each patient. Type of the study:Cross- sectional study. Methods: Thirty five patients,with mean age of about (62.8) years, were enrolled in this prospective, hospital based study that was held at Al-Yarmouk Teaching Hospital in Baghdad from October 2012 to November 2016. These patients were divided into 2 groups, first group was composed of 19 patients who have TKA with patellar circumferential denervation by electrocautery with patelloplasty by removing peripheral osteophytes of patella , the second group of 16 patients were undergone TKA without denervation, but only patelloplasty. The second group was considered as the control group. Visual analogue scale (VAS) was used to evaluate pain pre and post operatively. The patient’s functional ability was assessed by knee society score (KSS) also before and after TKA for both groups and pain killer was given according to patients need. Results: All of the patients were followed for 12 months period. No drugs were used other than occasional use of pain killers in first month after operation for all patients in group one of study. On VAS scale, significant statistical difference in pre and post-operative scales were noticed between both groups of study. The Knee Society Scale (KSS) was showing a non- significant statistical significance between both study groups before and after TKA. ConclusionA: nterior knee pain can be reduced through the use of patelloplasty with circumferential denervation of patella byelectrocautery, compared with non- denervated procedure. Good clinical outcome was also present.

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“…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.…”

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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Patellar Resurfacing Versus Circumferential Denervation of the Patella in Total Knee Arthroplasty

Cited by 14 publications

References 23 publications

Effect of Patellar Denervation on Anterior Knee Pain and Knee Function in Total Knee Arthroplasty without Patellar Resurfacing: A Meta‐Analysis of Randomized Controlled Trials

Effect of Patellar Denervation on Anterior Knee Pain and Knee Function in Total Knee Arthroplasty without Patellar Resurfacing: A Meta‐Analysis of Randomized Controlled Trials

Comparative study of anterior knee pain after patelloplasty with and without circumferential denervation in a total knee arthroplasty

Patellar management during total knee arthroplasty: a review

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