Fat pad excision in total knee arthroplasty does not affect functional outcome or anterior knee pain at 1 year follow-up

Background: Anterior knee pain (AKP) following total knee arthroplasty (TKA) is one of the complication which cause dissatisfaction in patients. Incidence estimated to be 4-49%. The aim of our study is to know the efficacy of patelloplasty with circumpatellar denervation with diathermy in reducing AKP in primary TKA.Methods: A total of 130 unilateral TKAs’ are divided into 2 groups. Group I (control) includes 65 patients in which only patelloplasty was done. Group II (intervention) includes 65 patients in which both patelloplasty and circumpatellar denervation with diathermy was done and analysed. Mean follow up period was 18 months. Patients were assessed both preoperatively and postoperatively at final follow up.Results: The overall incidence of AKP at follow up (18 months) was 16.9%, with 7.7% in the intervention group and 26.1% in the control group (p<0.05). Western Ontario and McMaster Universities osteoarthritis index scores were significantly better in intervention group when compared to control group (28.71±3.948 vs 31.40±3.860). Better results were also found in knee society scores for intervention group compared to control group (166.57±7.941 vs 161.23±11.219); Feller patellar score of intervention group was significantly better when compared to control group (23.28±2.546 vs 20.69±3.729); the range of knee flexion was similar in both the groups (94.62±12.6 vs 93.54±10.7). In terms of pain referred by the patient at 72 hrs postoperatively, there was statistically significant difference observed according to visual analogue scale.Conclusions: There is statistically significant difference with respect to AKP in patients who have undergone patelloplasty with circumpatellar denervation using diathermy compared with patelloplasty alone.

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Comparison between Mid-Term Results of Total Knee Arthroplasty with Single-Radius versus Multiple-Radii Posterior-Stabilized Prostheses

The Journal of Knee Surgery ◽

10.1055/s-0040-1713897 ◽

2020 ◽

Author(s):

Zhenyu Luo ◽

Kai Zhou ◽

Haoyang Wang ◽

Fuxing Pei ◽

Zongke Zhou

Keyword(s):

Total Knee Arthroplasty ◽

Knee Pain ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

Short Form ◽

Posterior Stabilized ◽

Total Knee ◽

Anterior Knee ◽

Single Radius

AbstractSingle-radius (SR) prostheses and multiple-radii (MR) prostheses have different theoretical advantages; however, few comparative studies have been reported. The aim of the study was to compare mid-term clinical, radiological, and survival outcomes of SR and MR posterior-stabilized prostheses in total knee arthroplasty (TKA). Two hundred consecutive patients who underwent TKA between January 2012 and July 2013 were enrolled in the SR group (100 patients) and an MR group (100 patients), with a minimum follow-up of 5 years. Functional, radiological, satisfaction, and survival rates were evaluated. There was a significantly higher range of motion (ROM) in the SR group than in the MR group (flexion, 123.65 ± 10.12 degrees vs. 115.52 ± 10.03 degrees, p < 0.001). Quadriceps strength (3.05 ± 0.43 vs. 2.68 ± 0.58 kg, p = 0.025) and chair test results (80 [93.02%] vs. 69 [83.13%], p = 0.027) were better in the SR group than in the MR group. The SR group also had significantly less anterior knee pain (6 [6.98%] vs. 15 [18.07%], p < 0.05) and a better satisfaction rate than those in the MR group. No significant differences were observed in clinical scale scores such as Hospital for Special Surgery (HSS), Knee Society Score (KSS), and Short-Form 12 (SF-12), radiological results in terms of component position and radiolucent lines. The Kaplan–Meier survival curve estimates at 5 years were not significantly different (96.91% [95% confidence interval [CI]: 93.5–99.5%] vs. 94.86% [95% CI: 90.6–98.6%], p = 0.4696). The SR prosthesis design was better than that of the MR in terms of ROM, reduced anterior knee pain, contributions to better recovery of the extension mechanism, and higher satisfaction rates. The SR had similar results in clinical scales such as HSS, KSS, SF-12, radiological, or survival results to MR prostheses. More accurate measurements and longer-term follow-up are required.

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Patelloplasty in total knee arthroplasty with circumpatellar denervation versus without denervation – a randomized prospective study

Arthroplasty ◽

10.1186/s42836-020-00044-6 ◽

2020 ◽

Vol 2 (1) ◽

Author(s):

S. R. K. Deekshith ◽

K. J. Reddy ◽

R. Raviteja

Keyword(s):

Total Knee Arthroplasty ◽

Knee Pain ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

Kujala Score ◽

Significant Difference ◽

Total Knee ◽

The Mean ◽

Anterior Knee

Abstract Introduction Anterior knee pain is one of the major problems in total knee arthroplasty (TKA) and is often etiologically associated with a patellofemoral parts etiology. There is no consensus as to etiology or treatment. Denervation of the patella by electrocautery and patelloplasty along with removal of osteophytes have been used for treatment of anterior knee pain in TKA. The purpose of our study was to compare, in terms of the anterior knee pain and clinical outcomes of patelloplasty in total knee arthroplasty (TKA), patellar denervation by electrocautery and non-patellar-denervation treatment in a 2 year follow-up. Materials and methods This study was conducted in a total of 108 patients, who underwent TKA at our institution between June 2015 and December 2016. Patients age 55 to 80 years, who are suffering from osteoarthritis, rheumatoid arthritis of knee were included in this study. Patients were randomly allocated into patelloplasty with denervation group and non-denervation group. The denervation of the patella was done in electrocautery group using a monopolar coagulation diathermy set to 50 W. (Valleylab Inc., Boulder, CO). Postoperatively, patients were assessed at regular intervals of 3, 6, 9, 12, 24 months. To assess patient outcomes, we used questionnaires to determine the Knee Society score (KSS - knee and function scores), a specific patellofemoral pain questionnaire (Kujala score) range of motion (ROM) and a visual analogue scale (VAS) to assess anterior knee pain. Results The data obtained were analyzed using SPSS version 17.0. Continuous variables were expressed as mean ± SD. Of the 108 patients, 9 patients were lost to follow-up. Among the remaining 99 patients, 50 were included in denervation group and 49 in non-denervation group. In our study, there was no statistically significant difference in Mean KUJALA score preoperatively (p > 0.05). Postoperatively, the mean KUJALA score was significantly higher in denervation group at 3, 6, 9, 12, 24 months of follow-up when compared to TKR with no denervation (p < 0.05). There was no statistically significant difference in Mean VAS score preoperatively (p > 0.05). However, 6, 12 and 24 months after the operation, the mean VAS score was significantly lower in denervation group. There was no statistically significant difference in Mean KSS score preoperatively and postoperatively (p > 0.05). The mean ROM was significantly higher in denervation group than in the group of TKR with no denervation (p < 0.05). Conclusion In our study, less postoperative anterior knee pain, increased range of motion, significantly lower VAS scores were seen in the denervation group compared with non-denervation group. Circumferential denervation of patella during primary TKA along with patellar resurfacing is a safe procedure that improves patient satisfaction, decreases anterior knee pain and improves range of flexion in the postoperative period and at postoperative follow-ups.

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Midterm functional recovery of Total knee arthroplasty patients compared between the ATTUNE knee system and the press fit condylar (PFC) SIGMA knee system

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04464-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ekasame Vanitcharoenkul ◽

Aasis Unnanuntana

Keyword(s):

Total Knee Arthroplasty ◽

Knee Pain ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

Functional Outcomes ◽

Press Fit ◽

The Press ◽

Total Knee ◽

Anterior Knee

Abstract Background The ATTUNE Knee System is a new prosthetic design that has theoretical advantages over the Press Fit Condylar (PFC) Sigma Knee System specific to improved knee kinematics and patellofemoral joint tracking. This study aimed to evaluate functional outcomes compared between the ATTUNE and PFC Sigma designs at a minimum follow-up of 5 years. Methods We retrospectively reviewed data from total knee arthroplasty (TKA) patients who received either the ATTUNE or PFC Sigma system during November 2013 to February 2015 at Siriraj Hospital (Bangkok, Thailand). Functional outcomes were evaluated using Timed Up and Go (TUG) test, 2-min walk test (2MWT), modified knee score, numerical rating scale-pain, range of motion (ROM), and rate of anterior knee pain and crepitation at preoperation, 3-months, 1-year, and 5-years postoperatively. Results Of 113 patients, 59 and 54 received the PFC Sigma and ATTUNE systems, respectively. At a minimum of 5-years follow-up, all functional outcomes improved significantly from the preoperative period although TUG test and 2MWT declined significantly from 1- to 5-years postoperatively only in the PFC Sigma group. The mean ROM at 5-years postoperatively was significantly higher in ATTUNE than in PFC Sigma; however, the difference was small (116° vs. 110°, respectively; p = 0.041). There were no significant differences in any of the other outcome measurements, including anterior knee pain, clunking, and crepitation, between groups at any study time point. Conclusions Our results revealed no major differences in functional outcomes between the PFC Sigma and ATTUNE TKA designs at an intermediate-term follow-up of at least 5 years. Longer-term follow-up study is needed to evaluate the benefits of the ATTUNE design relative to polyethylene wear and the rate of aseptic loosening.

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Midterm Functional Recovery of Total Knee Arthroplasty Patients Compared Between the ATTUNE Knee System and the Press Fit Condylar (PFC) SIGMA Knee System

10.21203/rs.3.rs-403415/v1 ◽

2021 ◽

Author(s):

Ekasame Vanitcharoenkul ◽

Aasis Unnanuntana

Keyword(s):

Total Knee Arthroplasty ◽

Knee Pain ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

Functional Outcomes ◽

Press Fit ◽

The Press ◽

Total Knee ◽

Anterior Knee

Abstract Background The ATTUNE Knee System is a new prosthetic design that has theoretical advantages over the Press Fit Condylar (PFC) Sigma Knee System specific to improved knee kinematics and patellofemoral joint tracking. This study aimed to evaluate functional outcomes compared between the ATTUNE and PFC Sigma designs at a minimum follow-up of 5 years. Methods We retrospectively reviewed data from total knee arthroplasty patients who received either the ATTUNE or PFC Sigma system during November 2013 to February 2015 at Siriraj Hospital (Bangkok, Thailand). Functional outcomes were evaluated using timed up and go test, 2-minute walk test, modified knee score, numerical rating scale-pain, range of motion (ROM), and rate of anterior knee pain and crepitation at preoperation, 3-months, 1-year, and 5-years, postoperatively. Results Of 113 patients, 59 and 54 received the PFC Sigma and ATTUNE systems, respectively. At a minimum of 5-years follow-up, all functional outcomes improved significantly. Although the mean ROM at 5-years postoperatively was significantly higher in ATTUNE than in PFC Sigma, the difference was small (116° vs. 110°, respectively; p = 0.041). There were no significant differences in any of the other outcome measurements, including anterior knee pain, clunking, and crepitation, between groups at any study time point. Conclusions Our results revealed no major differences in functional outcomes between the PFC Sigma and ATTUNE TKA designs at an intermediate-term follow-up of at least 5 years. Longer-term follow-up study is needed to evaluate the benefits of the ATTUNE design relative to polyethylene wear and the rate of aseptic loosening.

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A Dutch Survey on Circumpatellar Electrocautery in Total Knee Arthroplasty

The Open Orthopaedics Journal ◽

10.2174/1874325001004010201 ◽

2010 ◽

Vol 4 (1) ◽

pp. 201-203 ◽

Cited By ~ 21

Author(s):

Hans-Peter W. van Jonbergen ◽

Alexander F.W. Barnaart ◽

Cees C.P.M. Verheyen

Keyword(s):

Total Knee Arthroplasty ◽

The Netherlands ◽

Knee Pain ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

Patellar Resurfacing ◽

Orthopedic Surgeons ◽

Unicompartmental Knee Arthroplasties ◽

Total Knee ◽

Anterior Knee

Introduction: Anterior knee pain following total knee arthroplasty is estimated to occur in 4-49% of patients. Some orthopedic surgeons use circumpatellar electrocautery (diathermy) to reduce the prevalence of postsurgical anterior knee pain; however, the extent of its use is unknown. Materials and Methodology: In April 2009, a postal questionnaire was sent to all 98 departments of orthopedic surgery in The Netherlands. The questions focused on the frequency of total knee arthroplasties, patellar resurfacing, and the use of circumpatellar electrocautery. Results: The response rate was 92%. A total of 18,876 TKAs, 2,096 unicompartmental knee arthroplasties, and 215 patellofemoral arthroplasties are performed yearly in The Netherlands by the responding orthopedic surgeons. Of the orthopedic surgeons performing TKA, 13% always use patellar resurfacing in total knee arthroplasty for osteoarthritis, 49% use selective patellar resurfacing, and 38% never use it. Fifty-six percent of orthopedic surgeons use circumpatellar electrocautery when not resurfacing the patella, and 32% use electrocautery when resurfacing the patella. Conclusion: There is no consensus among Dutch orthopedic surgeons on the use of patellar resurfacing or circumpatellar electrocautery in total knee replacement performed for osteoarthritis. A prospective clinical trial is currently underway to fully evaluate the effect of circumpatellar electrocautery on the prevalence of anterior knee pain following total knee arthroplasty.

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Anterior knee pain following primary total knee arthroplasty

World Journal of Orthopedics ◽

10.5312/wjo.v6.i10.795 ◽

2015 ◽

Vol 6 (10) ◽

pp. 795 ◽

Cited By ~ 21

Author(s):

David Shervin

Keyword(s):

Total Knee Arthroplasty ◽

Knee Pain ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

Primary Total Knee Arthroplasty ◽

Total Knee ◽

Anterior Knee ◽

Primary Total Knee

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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.

10.21203/rs.3.rs-26676/v1 ◽

2020 ◽

Author(s):

Hongzhi Liu ◽

Zhaohui Liu ◽

Qidong Zhang ◽

Wanshou Guo

Keyword(s):

Total Knee Arthroplasty ◽

Knee Pain ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

Meta Analysis ◽

Cochrane Library ◽

Significant Difference ◽

Patient Reported ◽

Total Knee ◽

Anterior Knee

Abstract 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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