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

• Main Authors: S. R. K. Deekshith, K. J. Reddy, R. Raviteja
• Format: Article
• Language: English
• Published: BMC 2020-09-01
• Series: Arthroplasty
• Subjects: Total knee arthroplasty; Anterior knee pain; Patelloplasty; Denervation
• Online Access: http://link.springer.com/article/10.1186/s42836-020-00044-6

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.