Selective patellar resurfacing with or without denervation as the ultimate answer: current concepts

Cameron-Donaldson, Michelle; Ifran, Nadia Nastassia; Budhiparama, Nicolaas C.

doi:10.1136/jisakos-2016-000095

Cited by 4 publications

(2 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Resultsmentioning

confidence: 99%

“…Participants noted geographical variations in practice, where resurfacing never occurs in some countries and in other countries is the norm; yet, patient outcomes do not differ. 48 Additionally, there are variations in outcomes across implant brands and types. 49 In the absence of reliable patient benefits (Outer setting), participants interpreted the move towards resurfacing as being defensive in preventing a temptation to resurface later, and as being largely guided by practitioner training and habits (Inner setting and Individual).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Surgical implementation gap: an interrupted time series analysis with interviews examining the impact of surgical trials on surgical practice in England

et al. 2022

View full text Add to dashboard Cite

ObjectivesLandmark studies published near the turn of the 21st century found an implementation gap concerning the effect of evidenced-based findings on clinical practice. The current study examines the uptake of six trials that produced actionable findings to describe the effects of evidence on practice and the reasons for those effects.DesignA sequential, explanatory mixed methods study was conducted. First, a quantitative study assessed whether actionable findings from large, publicly funded elective surgical trials influenced practice. Subsequently, qualitative interviews were conducted to explain the quantitative findings.SettingChanges in NHS-funded practice were tracked across hospitals in England. Interviews were conducted online.Data and participantsThe six surgical trials were funded and published by England’s National Institute for Health Research’s Health Technology Assessment programme between 2006 and 2015. Quantitative time series analyses used data about the frequencies or proportions of relevant surgical procedures conducted in England between 2001 and 2020. Subsequently, qualitative interviews were conducted with 25 participants including study authors, surgeons and other healthcare staff in the supply chain. Transcripts were coded to identify major temporal events and Consolidated Framework for Implementation Research (CFIR) domains/constructs that could influence implementation. Findings were synthesised by clinical area.ResultsThe quantitative analyses reveal that practice changed in accordance with findings for three trials. In one trial (percutaneous vs nasogastric tube feed after stroke), the change took a decade to occur. In another (patella resurfacing), change anticipated the trial findings. In the third (abdominal aortic aneurysm repair), changes tracked the evolving evidence base. In the remaining trials (two about varicose veins and one about gastric reflux), practice did not change in line with findings. For varicose veins, the results were superseded by a further trial. For gastric reflux, surgical referrals declined as medical treatment increased. The exploratory qualitative analysis informed by CFIR found that evidence from sources apart from the trial in question was mentioned as a reason for non-adoption in the three trials where evidence did not affect practice and in the trial where uptake was delayed. There were no other consistent patterns in the qualitative data.ConclusionWhile practice does not always change in the direction indicated by clinical trials, our results suggest that individuals, official committees and professional societies do assimilate trial evidence. Decision-makers seem to respond to the totality of evidence such that there are often plausible reasons for not adopting the evidence of any one trial in isolation.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Surgical implementation gap: an interrupted time series analysis with interviews examining the impact of surgical trials on surgical practice in England

et al. 2022

View full text Add to dashboard Cite

show abstract

Does Circumferential Patellar Denervation Result in Decreased Knee Pain and Improved Patient-reported Outcomes in Patients Undergoing Nonresurfaced, Simultaneous Bilateral TKA?

Budhiparama

Hidayat

Novito

et al. 2019

Clin Orthop Relat Res

View full text Add to dashboard Cite

Background Anterior knee pain, which has a prevalence of 4% to 49% after TKA, may be a cause of patient dissatisfaction after TKA. To limit the occurrence of anterior knee pain, patellar denervation with electrocautery has been proposed. However, studies have disagreed as to the efficacy of this procedure. Questions/purposes We evaluated patients undergoing bilateral, simultaneous TKA procedures without patellar resurfacing to ask: (1) Does circumferential patellar cauterization decrease anterior knee pain (Kujala score) postoperatively compared with non-cauterization of the patella? (2) Does circumferential patellar cauterization result in better functional outcomes based on patient report (VAS score, Oxford knee score, and Knee Injury and Osteoarthritis Outcome Score) than non-cauterization of the patella? (3) Is there any difference in the complication rate (infection, patellar maltracking, fracture, venous thromboembolism, or reoperation rate) between cauterized patellae and non-cauterized patellae? Methods Seventy-eight patients (156 knees) were included in this prospective, quasi-randomized study, with each patient serving as his or her own control. Patellar cauterization was always performed on the right knee during simultaneous, bilateral TKA. Five patients (6%) were lost to follow-up before the 2-year minimum follow-up interval. A single surgeon performed all TKAs using the same type of implant, and osteophyte excision was performed in all patellae, which were left unresurfaced. Patellar cauterization was performed at 2 mm to 3 mm deep and approximately 5 mm circumferentially away from the patellar rim. The preoperative femorotibial angle and degree of osteoarthritis (according to the Kellgren-Lawrence grading system) were measured. Restoration of the patellofemoral joint was assessed using the anterior condylar ratio. Clinical outcomes, consisting of clinician-reported outcomes (ROM and Kujala score) and patient-reported outcomes (VAS pain score, Oxford knee score, and Knee Injury and Osteoarthritis Outcome Score), were evaluated preoperatively and at 1 month and 2 years postoperatively. Preoperatively, the radiologic severity of osteoarthritis, based on the Kellgren-Lawrence classification, was not different between the two groups, nor were the baseline pain and knee scores. The mean femorotibial angle of the two groups was also comparable: 189° ± 4.9° and 191° ± 6.3° preoperatively (p = 0.051) and 177° ± 2.9° and 178° ± 2.1° postoperatively (p = 0.751) for cauterized and non-cauterized knees, respectively. The preoperative (0.3 ± 0.06 versus 0.3 ± 0.07; p = 0.744) and postoperative (0.3 ± 0.06 versus 0.2 ± 0.07; p = 0.192) anterior condylar ratios were also not different between the cauterized and non-cauterized groups. Results At the 2-year follow-up interval, no difference was observed in the mean Kujala score (82 ± 2.9 and 83 ± 2.6 for cauterized and non-cauterized knees, respectively; mean difference 0.3; 95% confidence interval, -0.599 to 1.202; p = 0.509). The mean VAS pain score was 3 ± 0.9 in the cauterized knee and 3 ± 0.7 in the non-cauterized knee (p = 0.920). The mean ROM was 123° ± 10.8° in the cauterized knee and 123° ± 10.2° in the non-cauterized knee (p = 0.783). There was no difference between cauterized and non-cauterized patellae in the mean Knee Injury and Osteoarthritis Outcome Score for symptoms (86 ± 4.5 versus 86 ± 3.9; p = 0.884), pain (86 ± 3.8 versus 86 ± 3.6; p = 0.905), activities (83 ± 3.2 versus 83 ± 2.8; p = 0.967), sports (42 ± 11.3 versus 43 ± 11.4; p = 0.942), and quality of life (83 ± 4.9 versus 83 ± 4.7; p = 0.916), as well as in the Oxford knee score (40 ± 2.1 versus 41 ± 1.9; p = 0.771). Complications were uncommon and there were no differences between the groups (one deep venous thromboembolism in the cauterized group and two in the control group; odds ratio 0.49, 95% CI, 0.04-5.56; p = 0.57). Conclusions Patellar cauterization results in no difference in anterior knee pain, functional outcomes, and complication rates compared with non-cauterization of the patella in patients who undergo non-resurfaced, simultaneous, bilateral, primary TKA with a minimum of 2 years of follow-up. We do not recommend circumferential patellar cauterization in non-resurfaced patellae in patients who undergo TKA. Level of Evidence Level II, therapeutic study.

show abstract

Usually, Selectively, or Rarely Resurfacing the Patella During Primary Total Knee Arthroplasty

Maney

Koh

Frampton

et al. 2019

The Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Background: Surgeons may “usually” resurface the patella during total knee arthroplasty (TKA), “rarely” resurface, or “selectively” resurface on the basis of certain criteria. It is unknown which of these 3 strategies yields superior outcomes. Utilizing New Zealand Joint Registry data, we investigated (1) what proportion of surgeons employs each of the 3 patellar resurfacing strategies, (2) which strategy is associated with the lowest overall revision rate, and (3) which strategy is associated with the highest 6-month and 5-year Oxford Knee Score (OKS). Methods: Two hundred and three surgeons who performed a total of 57,766 primary TKAs from 1999 to 2015 were categorized into the 3 surgeon strategies on the basis of how often they resurfaced the patella during primary total knee arthroplasty; with “rarely” defined as <10% of the time, “selectively” as ≥10% to ≤90%, and “usually” as >90%. For each strategy, the cumulative incidence of all-cause revision was calculated and utilized to construct Kaplan-Meier survival curves. The mean 6-month and 5-year postoperative OKS for each group were utilized for comparison. Results: Overall, 57% of surgeons selectively resurfaced, 37% rarely resurfaced, and 7% usually resurfaced. The usually resurfacing group was associated with the highest mean OKS at both 6 months (38.57; p < 0.001) and 5 years postoperatively (41.34; p = 0.029), followed by the selectively resurfacing group (6-month OKS, 37.79; 5-year OKS, 40.87) and the rarely resurfacing group (6-month OKS, 36.92; 5-year OKS, 40.02). Overall, there was no difference in the revision rate per 100 component years among the rarely (0.46), selectively (0.52), or usually (0.46) resurfacing groups (p = 0.587). Posterior-stabilized TKAs that were performed by surgeons who selectively resurfaced had a lower revision rate (0.54) than those by surgeons who usually resurfaced (0.64) or rarely resurfaced (0.74; p < 0.001). Conclusions: Usually resurfacing the patella was associated with improved patient-reported outcomes, but there was no difference in overall revision rates among the 3 strategies. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

show abstract

Selective patellar resurfacing with or without denervation as the ultimate answer: current concepts

Cited by 4 publications

References 42 publications

Surgical implementation gap: an interrupted time series analysis with interviews examining the impact of surgical trials on surgical practice in England

Surgical implementation gap: an interrupted time series analysis with interviews examining the impact of surgical trials on surgical practice in England

Does Circumferential Patellar Denervation Result in Decreased Knee Pain and Improved Patient-reported Outcomes in Patients Undergoing Nonresurfaced, Simultaneous Bilateral TKA?

Usually, Selectively, or Rarely Resurfacing the Patella During Primary Total Knee Arthroplasty

Contact Info

Product

Resources

About