Effect of Patellar Resurfacing on Clinical Outcomes, Range of Knee Motion and Anterior Knee Pain in Patients with Total Knee Arthroplasty

Abstract Objectives: In this study, we retrospectively compare the clinical results, range of knee motion and anterior knee pain in patients on whom we performed knee arthroplasty with and without patellar resurfacing. Thirty-eight patients were evaluated in the study. Knee Society scores, knee range of motion and anterior knee pain before and 12 months after surgery were detected. Patients were divided into two groups: resurfaced patellas and nonresurfaced patellas. There were 18 patients in the resurfaced group and 20 patients in the nonresurfaced group. Mean Knee Society score was 40.72±13.09 in the resur-faced group and 38.55±5.88 in the nonresurfaced group before surgery. Mean Knee Society score was 80.38±7.78 in the resur-faced group and 80.10±3.22 in the nonresurfaced group in the last control. Mean knee range of motion was 92.83±12.12 degrees in the resurfaced group and 91.05±10.10 degrees in the nonresurfaced group before surgery. Mean range of motion was 106.22±9.13 degrees in the resurfaced group and 97.25±8.50 degrees in the nonresurfaced group after surgery. There were twelve patients with anterior pain before surgery in the resur-faced group and 13 patients with anterior knee pain before surgery in the nonresurfaced group. After surgery, there was one patient with anterior pain in the resurfaced group and 9 patients with anterior knee pain in the nonresurfaced group. Anterior knee pain ratio was smaller in the resurfaced group than in the nonresurfaced group, and there was a significant difference in range of knee motion as a result of our study. We offered to resurface the patella.

Download Full-text

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.

Download Full-text

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200046 ◽

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

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.

Download Full-text

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.

Download Full-text

Does the grading of chondromalacia patellae influence anterior knee pain following total knee arthroplasty without patellar resurfacing?

International Orthopaedics ◽

10.1007/s00264-017-3658-0 ◽

2017 ◽

Vol 42 (3) ◽

pp. 513-518 ◽

Cited By ~ 2

Author(s):

Guo-Chun Zha ◽

Shuo Feng ◽

Xiang-Yang Chen ◽

Kai-Jin Guo

Keyword(s):

Total Knee Arthroplasty ◽

Knee Pain ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

Patellar Resurfacing ◽

Chondromalacia Patellae ◽

Total Knee ◽

Anterior Knee

Download Full-text

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

10.21203/rs.2.15386/v2 ◽

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

Download Full-text

Outerbridge classification as a predictor for the need of patellar resurfacement in total knee arthroplasty: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170785 ◽

2017 ◽

Vol 3 (2) ◽

pp. 266

Author(s):

Sanjay Puri ◽

Manoj Kashid ◽

Gopal Shinde ◽

Tushar Gogia ◽

Praveen Shrivastava ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

P Value ◽

Patellar Resurfacing ◽

Class Iii ◽

Significant Difference ◽

Total Knee ◽

Anterior Knee ◽

Hss Score

Background: Residual anterior knee pain after total knee arthroplasty is one of the common causes of early revision surgery in form of patellar resurfacing and even resurfacing the patella in these circumstances may not relieve the symptoms. So, the decision to perform patellar resurfacing during total knee arthroplasty to prevent anterior knee pain remains controversial. The purpose of this study is to determine if the outerbridge classification can predict the need for Patellar resurfacing as part of total knee arthroplasty.Methods: 100 patients with advanced osteoarthritis of knee fulfilling the inclusion and exclusion criteria were randomized into two groups of 50 patients each. In group A-patellar resurfacing done and in group B-patella was not resurfaced while carrying out TKR. Each patient was assessed intraoperatively and his/her patella classified as per Outerbridge classification. Patients were followed-up at 03, 06 and 12 months postoperatively and assessed by modified hospital for special surgery (HSS) knee scores.Results: In case of Outerbridge class III group there is a statistically significant difference (p value -0.002) in HSS score at 03 months, which becomes highly significant at 06 months (p value -0.001) and 01 year (p value <0.001). Similarly, there is statistically significant difference in HSS score (p value- 0.001) in Outerbridge class IV group at 03 months, 06 months and 01 year.Conclusions: Patellar resurfacing in patients undergoing total knee arthroplasty with patella in Outerbridge class III and IV can be safely carried out to further improve the functional outcome. There is no distinct advantage of resurfacing patella in Outerbridge class I and II in terms of functional gain. Thus, Outerbridge classification for patella can effectively guide us whether to resurface patella or not in patients undergoing total knee arthroplasty.

Download Full-text

The Effect of Patellar Denervation by Circumpatellar Electrocautery on Anterior Knee Pain Following Total Knee Replacement – An Experimental Study

Reconstructive Review ◽

10.15438/rr.7.2.173 ◽

2017 ◽

Vol 7 (2) ◽

Cited By ~ 1

Author(s):

Balaji Zacharia ◽

Manu Paul

Keyword(s):

Knee Pain ◽

Anterior Knee Pain ◽

Knee Society Score ◽

Clinical Score ◽

Total Sample ◽

P Value ◽

Medical College ◽

Significant Difference ◽

Anterior Knee

ABSTRACTOBJECTIVESAnterior knee pain is a common problem in patients who have undergone TKR which causes dissatisfaction among them. There are Various methods for prevention of anterior knee pain following TKR .The objective of this study is to determine the effect of circumpatellar electrocautery on anterior knee pain following TKR and to compare the results with that of those patients who have undergone TKR without circumpatellar denervation.METHODSThis is a cohort study conducted in Dept. of Orthopedics, Govt. Medical College, Kozhikode,kerala, 2014. Total sample size was 90.out of which 2 patients died during the study period. We lost follow up of 7 patients. Among the remaining 81 patients 42 had undergone TKR with circumpatellar denervation using electocautery and 39 without circumpatellar denervation. They were kept under follow up. Patients were followed up postoperatively at 1 month, 3 months, 6 months and at one year. At all postoperative visits, a clinical score was determined using the Knee Society score and the clinical anterior knee pain rating system described by Waters and BentleyRESULTSThere is no statistically significant difference in AKP score between both groups.There is a statistically significant difference in the knee society score at 1st month(p value <.001). But there is no difference on further follow up visits .CONCLUSIONThere is no statistically significant difference between final outcome of patients who underwent patella denervation using circumpatellar electrocauterisation and those without denervation with respect to anterior knee pain among patients who have undergone TKR.

Download Full-text