Anterior knee pain causes after total knee arthroplasty

The objective of the study was to determine the causes of postoperative anterior knee pain after total knee arthroplasty for preventing its occurrence and improving the surgery results.The treatment results of 77 (112 cases) patients with cruciate-retaining total knee arthroplasty without patellar replacement were analyzed. The study involved 62 (80.5 %) women and 15 (19.5 %) men. The average age (Me (25‒75 %)) of the patients was 65 (60‒70) years. There were 97 cases (87 %) with varus deformity of the knee joint, 15 cases with valgus deformity (13 %). The average angle of varus deformity was 11.22 ± 3.81°, the average angle of valgus deformity was 11 ± 4.27°. After the anterior pain appeared, patients were examined in 2‒3, 4‒5 and 6‒7 months after surgery using clinical, X-ray (anterior-posterior, lateral and axial projections, topogram of lower extremities), and EMG methods.The causes of anterior postoperative knee pain were: implant components misplacement, patellar microcirculation disorders (chondrolysis, avascular necrosis due to circular patella denervation), patellofemoral joint imbalance, and functional causes. Pain manifested itself at active leg loading and knee motion because of implant components misplacement within 2‒3 months in 34 cases (94 %), 4‒5 months ‒ in 2 cases (6 %). Patellar microcirculation disorders within 4‒5 months ‒ in 5 cases (21 %), 6‒7 months ‒ in 19 (79 %) cases. Imbalance in the patellofemoral joint within 2‒3 months ‒ in 29 cases (69 %), 4‒5 months ‒ in 13 cases (31 %). Functional causes of pain appeared within 2‒3 months ‒ in 7 cases (70 %), 4‒5 months ‒ in 3 cases (30 %).The causes of postoperative anterior pain in total knee arthroplasty can be incorrect surgical technique, changes in patellar blood supply or in the biomechanics of the patellofemoral joint due to the imbalance of the thigh muscles.

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

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

Download Full-text

Effect of medial–lateral malpositioning of the femoral component in total knee arthroplasty on anterior knee pain at greater than 8years of follow-up

The Knee ◽

10.1016/j.knee.2014.08.007 ◽

2014 ◽

Vol 21 (6) ◽

pp. 1258-1262 ◽

Cited By ~ 7

Author(s):

S.A.W. van de Groes ◽

S. Koëter ◽

M. de Waal Malefijt ◽

N. Verdonschot

Keyword(s):

Total Knee Arthroplasty ◽

Femoral Component ◽

Knee Pain ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

Total Knee ◽

Anterior Knee

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