The Effect of Electrocautery around the Patellar Rim in Patellar Non-Resurfacing Total Knee Arthroplasty

Yim, Soo Jae; Jang, Mun Suk; Kim, Wook Joong; Lee, Sang Hyok; Kang, Hee Kyung

doi:10.5792/ksrr.2012.24.2.104

Cited by 24 publications

(66 citation statements)

References 20 publications

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“…4,11,12 The results of this study demonstrate that the group that underwent PD showed significantly better results for the postoperative knee functional scores. Because no significant differences occurred for gender and BMI between groups, we assumed that these variables did not interfere substantially in the analysis of the results, a fact corroborated by the lack of correlation of the variables used to determine knee function and pain.…”

Section: ■ Discussionmentioning

confidence: 57%

Patellar denervation for Anterior Knee Pain Management in Knee Arthroplasty

et al. 2017

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OBJECTIVE:To compare the effectiveness of patellar denervation versus non-patellar denervation in reducing anterior knee pain on a follow-up period of at least one year after total knee arthroplasty. METHOD: Data from 84 patients, who underwent total knee arthroplasty were analyzed. Participants were divided into 2 groups; group A: 42 patients who previously underwent total knee arthroplasty with patellar denervation; and group B: 42 patients who previously underwent total knee arthroplasty without patellar denervation. Results were evaluated using WOMAC and KSS questionnaires, and the VAS pain measurement. Knee ranges of motion were measured. Preoperative clinical conditions of both groups were similar. RESULTS: Postoperatively, the following results were observed. (a), the WOMAC scores for group A were significant better when compared to group B (27.95 ± 5.89 vs. 33,55 ± 6.23; (b) better results were also found in KSS scores for group A vs. group B (86.19 ± 7.10 vs. 83,07 ± 4.88); (c) the range of knee flexion was smaller than in group A vs. group B (119.0 ± 10.7 vs 125.5 ± 11.0 degrees); (d) there was no significant difference between the mean of range of knee extension between the two groups groups; (e) in terms pain referred by the patient, no difference was observed according to VAS pain. CONCLUSION: Patellar denervation does not show better effect in pain reduction compared with TKA with non-patellar denervation. However, it had a better beneficial effect on knee function score, as measured through the KSS and WOMAC questionnaires. This procedure has become quite common, especially in the last two decades due to the aging of population and to the growing number of obese people. 2,3One of the most common problems during the postoperative period of this procedure is the incidence of anterior knee pain (AKP). About 10 to 15% of patients undergoing surgery will show these symptoms. It is noteworthy that the presence of pain is of utmost importance when evaluating the results of TKA, because patient satisfaction is linked to its presence or absence during the postoperative period. 4,5 Some authors assign the AKP to the distribution of nerve fibers and P-substance in soft tissues around the knee, suggesting a relation with hyper-innervation of peripatellar soft tissues. Therefore, disabling these nerve fibers by electrocautery could, in theory, achieve a satisfactory level of denervation and, consequently, reduce local pain. 1,6 Studies have shown a positive effect of patellar denervation in reducing the incidence of AKP. 7,8 A recent meta-analysis demonstrated that patellar denervation

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Section: ■ Discussionmentioning

confidence: 57%

Patellar denervation for Anterior Knee Pain Management in Knee Arthroplasty

et al. 2017

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“…A large number of patients could increase the reliability of meta-analysis. Secondly, the risk factors were inconsistent in above RCTs [1,4,[19][20][21]28]. For example, female gender, ages, days of follow-up and depth of circumpatellar electrocautery were considered as risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, all studies reported outcomes they planed previously, suggesting a low risk of bias. Five studies reported that they did not receive any commercial funding or grants in support of their research [1,[19][20][21]28], whereas one study received financial grants from commercial supports [4]. No other apparent bias was found among the included studies.…”

Section: Quality Of the Included Studiesmentioning

confidence: 99%

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

Zhang

Líu²,

Yan

et al. 2015

Knee Surg Sports Traumatol Arthrosc

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“…Previous studies have compared the outcomes of denervation and no denervation patellae in patients following primary TKA [7]. Although some studies have revealed that patellar denervation (PD) may decrease the incidence of anterior knee pain [2,8,9], others have indicated that patellar denervation had no substantial effect during follow-up [3,10,11,12,13].…”

Section: Introductionmentioning

confidence: 99%

Does patellar denervation prevent anterior knee pain and improve patient-reported outcomes in patients undergoing non-resurfaced total knee arthroplasty? an updated meta-analysis of randomized controlled trials.

Liu

Zhang

et al. 2020

Preprint

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Background Anterior knee pain (AKP) is the most common complication of total knee arthroplasty (TKA). It is unclear which procedure of addressing AKP is preferable. Some data suggest patellar denervation (PD) provides effective AKP prevention. The purpose was to assess the effectiveness and safety of PD in primary TKA.Methods A meta-analysis was performed of randomized clinical trials (RCTs) from inception to March 26, 2020, using PubMed, Embase, Web of Science and Cochrane Library. Study-specific RR and MD were aggregated using random or fixed effects models. The outcomes were incidences of AKP, PS (patellar scores), VAS (visual analogue scale), ROM (range of motion), KSS knee (American Knee Society knee scores), KSS function (American Knee Society function scores), incidence of complications and revisions.Results Ten RCTs involving 1196 knees were included. The meta-analysis showed no significant in PD group on the incidence of AKP (RR = 0.64; 95% CI 0.37, 1.11; p = 0.11) with moderate heterogeneity (P < 0.01, I2 = 84%). Our results indicated PD had a significantly better VAS (MD = − 0.25; 95% CI -0.41, -0.09; p < 0.01), ROM (MD = 7.68; 95% CI 0.34, 15.20; p = 0.04) and PS (MD = 0.91; 95% CI 0.36, 1.46; p < 0.01). However, there was no significant difference no matter in KSS knee, KSS function, complications or revisions.Conclusions This meta-analysis showed that no difference in AKP between PD and NPD in patients undergoing non-resurfaced TKA. PD could improve clinical outcome in VAS, post-operative ROM and PS.

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The Effect of Electrocautery around the Patellar Rim in Patellar Non-Resurfacing Total Knee Arthroplasty

Cited by 24 publications

References 20 publications

Patellar denervation for Anterior Knee Pain Management in Knee Arthroplasty

Patellar denervation for Anterior Knee Pain Management in Knee Arthroplasty

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

Does patellar denervation prevent anterior knee pain and improve patient-reported outcomes in patients undergoing non-resurfaced total knee arthroplasty? an updated meta-analysis of randomized controlled trials.

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