Journal of Orthopedic Research and Therapy (ISSN: 2575-8241)

research article

Patelloplasty in Total Knee Arthroplasty with Circumpatellar Denervation Versus without Denervation - A Randomized Prospective Trial

Kankanala J Reddy*, S.R.K. Dikshith, R. Raviteja

Department of Orthopedics, SVS medical college and hospital, Mahbubnagar, Telangana, India

*Corresponding author: Kankanala J Reddy, Department of Orthopedics, SVS medical college and hospital,

Mahbubnagar - 509001, Telangana, India. Tel: +91-0854225632; Fax: +91-0854225632; Email: kjreddy@hotmail.co.uk

Received Date: 14 May, 2018; Accepted Date: 01 June, 2018; Published Date: 08 June, 2018

1.       Abstract

4.1.  Introduction: Anterior knee pain is still a major problem in Total Knee Arthroplasty (TKA). Although the most widely accepted opinion is that anterior knee pain is often associated with a patellofemoral etiology, there is no clear consensus as to etiology or treatment. In general, denervation of the patella by electrocautery and patelloplasty with removal of osteophytes have been used for treatment of anterior knee pain in TKA. The purpose of our study is to compare the anterior knee pain and clinical outcomes of patelloplasty in Total Knee Arthroplasty (TKA) with patellar denervation by electrocautery and without patellar denervation at a minimum follow-up of 1year.

4.2.  Materials and Methods: This study was conducted among a total of 108 patients, who underwent TKA at our institution between June 2015 and December 2016. Patients between 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). post-operatively, Patients are assessed at regular intervals of 3, 6, 9, 12, months. To assess patient outcome, questionnaires to determine the Knee Society score (KSS - knee and function scores), a specific patellofemoral pain questionnaire (Kujala score) including the patella score, range of motion (ROM) and a visual analogue scale (VAS) to assess anterior knee pain were used.

4.3.  Results: The data obtained was analyzed using SPSS version 17.0. Continuous variables were expressed as mean ± SD values. Of the 108 patients, 9 patients were lost for 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). Post operatively, the mean KUJALA score was significantly higher in denervation group at 3,6,9,12 months 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, post operatively at 6months, 12 months and 24 months the mean VAS score was significantly lower in denervation group. There was no statistically significant difference in Mean KSS score preoperatively and post operatively (p>0.05). The mean ROM was significantly higher in denervation group than when compared to TKR with no denervation p<0.05.

4.4.  Conclusion: In our study, there less postoperative anterior knee pain, increased range of motion, significant lower VAS scores in denervation group compared with non-denervation group. In conclusion, circumferential denervation of patella during primary TKA with patellar resurfacing appears to be a safe procedure that may improve patient satisfaction, decrease anterior knee pain and improve range of flexion in the post-operative period and at follow up visits post-operatively.

2.       Keywords: Anterior Knee Pain; Denervation; Patelloplasty; Total Knee Arthroplasty


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