scholarly journals Patelloplasty with and without circumpatellar denervation in reducing anterior knee pain in primary total knee arthroplasty: a comparative prospective study

2020 ◽  
Vol 6 (2) ◽  
pp. 270
Author(s):  
Sandeep Kumar Kanugula ◽  
Mallesh Rathod ◽  
Venugopal S. M.
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Anterior Knee Pain ◽  
Intervention Group ◽  
Control Group ◽  
Significant Difference ◽  
Total Knee ◽  
Anterior Knee

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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&lt;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.</p><p class="abstract"><strong>Conclusions:</strong> There is statistically significant difference with respect to AKP in patients who have undergone patelloplasty with circumpatellar denervation using diathermy compared with patelloplasty alone.</p><p> </p>

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

Arthroplasty ◽  
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.

scholarly journals 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.

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.

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

2018 ◽  
Vol 5 (1) ◽  
pp. 29-32
Author(s):  
Sameer Rathore ◽  
Nithin Vadlamudi ◽  
Yellati Lvsnr ◽  
A.H. Ashwin Kumar ◽  
Indukuri Viswanatha Reddy ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Functional Outcome ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Anterior Knee Pain ◽  
Fat Pad ◽  
Total Knee ◽  
Anterior Knee

scholarly journals Influence of femoral implant design modification on anterior knee pain and patellar crepitus in patients who underwent total knee arthroplasty without patella resurfacing

2020 ◽  
Author(s):  
Yifan Huang ◽  
Yuhang Gao ◽  
Lu Ding ◽  
Bo Liu ◽  
Jianguo Liu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Anterior Knee Pain ◽  
Implant Design ◽  
Control Group ◽  
Patellar Resurfacing ◽  
Design Modification ◽  
Total Knee ◽  
Anterior Knee

Abstract Background : The incidence of patient dissatisfaction due to multiple factors, especially anterior knee pain (AKP) and patellar crepitus after total knee arthroplasty (TKA), remain a concern. Improvements in the femoral component of the traditional prosthesis could reduce the incidence of these complications in TKA performed with patellar resurfacing. This study aimed to explore whether TKA without patellar resurfacing benefits from this modification in femoral implant design with regard to AKP and patellar crepitus. Methods : Sixty-two patients (85 knees) who underwent TKA with the modern prosthesis and 62 age- and sex-matched patients (90 knees) fitted with the traditional prosthesis were enrolled in this study. The incidence of AKP and patellar crepitus, and Knee Society Score (KSS) was recorded. Statistical analyses were performed to determine whether there were differences between the groups. Results: The incidence of AKP was significantly lower in the study group compared with the control group at the 3-month and 1-year follow-ups (4.7% vs. 13.3% [ p =0.048] and 3.5% vs. 13.3% [ p =0.021], respectively). The incidence of patellar crepitus was significantly lower in the study group compared with the control group at the 3-month and 1-year follow-ups (15.3% vs. 34.4% [ p =0.004] and 10.6% vs. 28.9% [ p =0.002], respectively). There was no significant difference in KSS between the groups. Conclusion : Results revealed that TKA without patellar resurfacing benefited from the femoral implant design modification with regard to AKP and patellar crepitus. These data may be meaningful to surgeons who use the modern prosthesis and omit resurfacing the patella in their patients. Keywords : total knee arthroplasty, femoral component, prosthesis design, anterior knee pain, patellar crepitus

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

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.

scholarly journals Influence of femoral implant design modification on anterior knee pain and patellar crepitus in patients who underwent total knee arthroplasty without patella resurfacing

2019 ◽  
Author(s):  
Yifan Huang ◽  
Yuhang Gao ◽  
Lu Ding ◽  
Bo Liu ◽  
Jianguo Liu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Anterior Knee Pain ◽  
Implant Design ◽  
Control Group ◽  
Study Group ◽  
Design Modification ◽  
Total Knee ◽  
Anterior Knee

Abstract Background: The incidence of dissatisfaction that due to multiple factors especially anterior knee pain (AKP) and patellar crepitus after total knee arthroplasty (TKA) are still required concern. Improvements of femoral component in traditional prosthesis could reduce the incidence of these complications in TKA with patella resurfacing. This study aimed to explore whether TKA without patella resurfacing benefit from this femoral implant design modification in the aspects of AKP and patellar crepitus.Methods: Sixty-two patients (85 knees) using the modern prosthesis and 62 age-matched and sex-matched patients (90 knees) using the traditional prosthesis were enrolled in this study. The incidences of AKP and patellar crepitus, Knee Society Scores were recorded. Statistical analyses were accomplished to determine if there were differences between the two groups. Results: The incidence of AKP was significantly lower in the study group compared with those in the control group at 3-month and 1-year follow-up (4.7% vs. 13.3%, p = 0.048; 3.5% vs. 13.3%, p = 0.021, respectively). The incidence of patellar crepitus was significantly lower in the study group compared with those in the control group at 3-month and 1-year follow-up (34.4% vs. 15.3%, p = 0.004; 28.9% vs. 10.6% at 1 year, p = 0.002, respectively). There was no significant difference in Knee Society Scores between two groups.Conclusion: The results showed that TKA without patella resurfacing benefited from this femoral implant design modification in the aspects of AKP and patellar crepitus. This study may provide meaningful information for surgeons who use the modern prosthesis and selectively not resurfacing the patella in their patients.

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

2019 ◽  
Vol 13 (2) ◽  
pp. 106-110
Author(s):  
Ahmed Latteef Al-Shamari
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Anterior Knee Pain ◽  
Statistical Significance ◽  
Study Groups ◽  
Control Group ◽  
Before And After ◽  
Total Knee ◽  
Anterior Knee

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.   

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

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.

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

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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