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

Keywords: Total knee arthroplasty, anterior knee pain, Circumpatellar denervation

Abstract

ABSTRACT

OBJECTIVES

Anterior 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.

METHODS

This 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 Bentley

RESULTS

There 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 .

CONCLUSION

There 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.

 

References

after total knee arthroplasty: gender-related differences. J Arthroplasty 2011; 26(8):1475–1480

Bonnin MP, Basiglini L, Archbold HA. What are the factors of residual pain after uncomplicated TKA? Knee Surg Sports Traumatol Arthrosc 2011;19(9):1411–1417.

Liu SS, Buvanendran A, Rathmell JP, Sawhney M, Bae JJ, et al. Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int Orthop 2012; 36(11):2261–2267.

Schnurr C, Jarrous M, Güdden I, Eysel P, König DP. Pre-operative arthritis severity as a predictor for total knee arthroplasty patients’ satisfaction. Int Orthop 2013;37(7):1257–1261.

Forsythe ME, Dunbar MJ, Hennigar AW, Sullivan MJ, Gross M. Prospective relation between catastrophizing and residual pain following knee arthroplasty: two-year follow-up. Pain Res Manag 2008; 13(4): 335–341.

Anterior knee pain after a total knee arthroplasty: What can cause this pain. World Journal of Orthopedics 2014; 5(3): 163-170.

Saleh KJ, Lee LW, Gandhi R, Ingersoll CD, Mahomed NN et al. Quadriceps strength in relation to total knee arthroplasty outcomes. Instr Course Lect 2010; 59:119– 130

Lin F, Wilson NA, Makhsous M, Press JM, Koh JL, Nuber GW, Zhang LQ. In vivo patellar tracking induced by individual quadriceps components in individuals with patellofemoral pain. J Biomech 2010; 43(2):235–241.

LiK, AcklandDC, McClelland JA,Webster KE, Feller JA, de Steiger R, Pandy MG. Trunk muscle action compensates for reduced quadriceps force during walking after total knee arthroplasty. Gait Posture 2013; 38:79–85.

Tsuji T, Matsuyama Y, Goto M, Yimin Y, Sato K, Hasegawa Y, Ishiguro N. Knee-spine syndrome: correlation between sacral inclination and patellofemoral joint pain. J Orthop Sci 2002; 7(5):519–523.

Motsis EK, Paschos N, Pakos EE, Georgoulis AD. Patellar instability after total knee arthroplasty. J Orthop Surg (Hong Kong) 2009; 17:351–357.

Seil R, Pape D. Causes of failure and etiology of painful primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19(9):1418–1432.

van Jonbergen HP, Reuver JM, Mutsaerts EL, Poolman RW. Determinants of anterior knee pain following total knee replacement: a systematic review. Knee Surg Sports Traumatol Arthrosc 2012 Nov.18. [Epub ahead of print] PMID:23160846.

Bacher C et al. Posterior stabilized TKA reduce patellofemoral contact pressure compared with cruciate retaining TKA in vitro. Knee Surg Sports Traumatol Arthrosis 2009; 17(1): 1159-1165.

. Li N, Tan Y, Deng Y, Chen L (2012) Posterior cruciate-retaining versus posterior stabilized total knee arthroplasty: a meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc

Chonko DJ, Lombardi AV Jr, Berend KR. Patella baja and total knee arthroplasty (TKA): etiology, diagnosis, and management. Surg Technol Int 2004; 12:231–238.

Bhattee G,Moonot P, Govindaswamy R, Pope A, Fiddian N, Harvey A. Does malrotation of components correlate with patient dissatisfaction following secondary patellar resurfacing? The Knee 2013; 21(1): 247-251.

PagnanoMW, Hanssen AD, Lewallen DG, Stuart MJ. Flexion instability after primary posterior cruciate retaining total knee arthroplasty. Clin Orthop 1998; 356:39–46

Wetzner SM, Bezreh JS, Scott RD, Bierbaum BE, Newberg AH. Bone scanning in the assessment of patellar viability following knee replacement. Clin Orthop Relat Res. 1985;199:215–219

. Ortiguera CJ, Berry DJJ Patellar fracture after total knee arthroplasty Bone Joint Surg Am. 2002 Apr; 84-A(4):532-40

Lucas TS, DeLuca PF, Nazarian DG, Bartolozzi AR, Booth RE Jr. Arthroscopic treatment of patellar clunk. Clin Orthop 1999; 367: 226–229.

Lützner J, Hartmann A, Dinnebier G, Spornraft-Ragaller P, Hamann C, Kirschner S. Metal hypersensitivity and metal ion levels in patients with coated or uncoated total knee arthroplasty: a randomised controlled study. Int Orthop 2013; 37(1): 1925-1931.

A. Baco, G. Bentley and H. Alyawer patelloplasty in knee replacement JBone Joint Surg Br 2006

Gupta R, Canty S, Ryan W. Anterior knee pain following total knee replacement caused by isolated pagets disease of patella. The international Journal of Orthopaedic surgery 2007; 9(2).

Feller JA, Bartlett RJ, Lang DMPatellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br. 1996 Mar;78(2):226-8.

Wojtys EM, Beaman DN, Glover RA, Janda D. Innervation of the human knee joint by substance P fibres. Arthroscopy 1990; 6: 254-63.

Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989(248):13-4.

Waters TS, Bentley G. Patellar resurfacing in total knee arthroplasty: a prospective, randomized study. J Bone Joint Surg [Am] 2003; 85-A:212-17.

Baliga CJ, McNair KJ, Barnett J, MacLeod RW, Humphry D. Does circumpatellar electrocautery improve the outcome after total knee replacement? A prospective, randomised, blinded controlled trials. Finlayson. J Bone Joint Surg Br 2012; 94-B: 1228–33.

Yim SJ, Jang MS, Kim WJ, Lee SH, Kang HK. The Effect of Electrocautery around the Patellar Rim in Patellar Non-Resurfacing Total Knee Arthroplasty. Knee Surg Relat Res 2012;24(2):104-107.

van Jonbergen HPW, Scholtes VAB, van Kampen A, Poolman RW. A randomised, controlled trial of circumpatellar electrocautery in total knee replacement without patellar resurfacing. J Bone Joint Surg [Br] 2011; 93-B: 1054-9.

van Jonbergen HP, Scholtes VA, Poolman RW A randomised, controlled trial of circumpatellar electrocautery in total knee replacement without patellar resurfacing: a concise follow-up at a mean of 3.7 years..Bone Joint J. 2014 Apr;96-B(4):473-8.

Altay MA1, Ertürk C, Altay N, Akmeşe R, Işıkan UE. Patellar denervation in total knee arthroplasty without patellar resurfacing: a prospective, randomized controlled study. Orthop Traumatol Surg Res 2012; 98(4):421-5.

Cheng T, Zhu C, Guo Y, Shi S, Chen D, Zhang X Patellar denervation with electrocautery in total knee arthroplasty without patellar resurfacing: a meta-analysis..Knee Surg Sports Traumatol Arthrosc. 2014 Nov;22(11):2648-54

Li B1, Bai L, Fu Y, Wang G, He M, Wang JComparison of clinical outcomes between patellar resurfacing and nonresurfacing in total knee arthroplasty: retrospective study of 130 cases.. J Int Med Res. 2012;40(5):1794-803.

Published
2017-07-01
How to Cite
Zacharia, B., & Paul, M. (2017). The Effect of Patellar Denervation by Circumpatellar Electrocautery on Anterior Knee Pain Following Total Knee Replacement – An Experimental Study. Reconstructive Review, 7(2). https://doi.org/10.15438/rr.7.2.173
Section
Original Article