Skip to main content

Advertisement

Log in

The efficacy of patellar decompression for improving anterior knee pain following total knee arthroplasty without patellar resurfacing

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Anterior knee pain remains common following total knee arthroplasty (TKA). In this study, we evaluated the efficacy of patellar decompression via drilling for the treatment of anterior knee pain following TKA without patellar resurfacing.

Methods

A prospective cohort study was performed in 271 consecutive patients who underwent primary total knee replacement with patellar decompression (study group, n = 131) or without decompression (control group, n = 140). The patients were assessed according to the Knee Society rating, clinical anterior knee pain score, and British Orthopaedic Association patient-satisfaction score in each group. Each assessment was performed without the examiner knowing whether the patella had been decompressed. Radiographic evaluations were also performed according to the Knee Society scoring system for functional activity and our own severity grade system for patellofemoral articular change.

Results

There were no adverse events following patellar decompression. The overall prevalence of anterior knee pain was not significantly different between groups (p = 0.71). However, patients presenting pain over grade II after the operation in the study group were statistically low (p = 0.01). The overall postoperative knee scores were higher in the study group, but there were no significant differences between groups (p = 0.0731). Analyses of the radiographs revealed similar postoperative outcomes in both groups of knees.

Conclusions

As we observed significantly lower rates of anterior knee pain and no patellar complications following patellar decompression via drilling in TKA without patellar resurfacing, we recommend performing patellar decompression in cases of total knee replacement without patellar resurfacing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ghomrawi HM, Schackman BR, Mushlin AI (2012) Appropriateness criteria and elective procedures—total joint arthroplasty. N Engl J Med 367:2467–2469

    Article  PubMed  CAS  Google Scholar 

  2. Scott RD (2012) The evolving incidence and reasons for re-operation after fixed-bearing PCL retaining total knee arthroplasty. J Bone Joint Surg Br 94:134–136

    PubMed  CAS  Google Scholar 

  3. Richmond JC (2013) Surgery for osteoarthritis of the knee. Rheum Dis Clin North Am 39:203–211

    Article  PubMed  Google Scholar 

  4. Kim YM, Joo YB (2012) Patellofemoral osteoarthritis. Knee Surg Relat Res 24:193–200

    Article  PubMed  Google Scholar 

  5. Dye SF (2001) Patellofemoral pain current concept: an overview. Sports Med Arthroscopy Rev 9:306–311

    Article  Google Scholar 

  6. Arnold CC, Lemperg RK, Linderholm H (1975) Intraosseous hypertension and pain in the knee. J Bone Joint Surg Br 57:360–363

    Google Scholar 

  7. Leichtle UG, Wunschel M, Leichtle CI et al (2013) Increased patellofemoral pressure after TKA: an in vitro study. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2372-8

    PubMed  Google Scholar 

  8. Schneider U, Breusch SJ, Thomsen M, Graf J, Niethard FU (2000) A new concept in the treatment of anterior knee pain: patellar hypertension syndrome. Orthopedics 23:581–586

    PubMed  CAS  Google Scholar 

  9. Heyse TJ, Becher C, Kron N et al (2010) Patellofemoral pressure after TKA in vitro: highly conforming vs. posterior stabilized inlays. Arch Orthop Trauma Surg 130:191–196

    Article  PubMed  Google Scholar 

  10. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop 248:13–14

    PubMed  Google Scholar 

  11. Aichroth P, Freeman MAR, Smillie IS, Souter WA (1978) A knee function assessment chart. J Bone Joint Surg Br 60:308–309

    Google Scholar 

  12. Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop 248:9–12

    PubMed  Google Scholar 

  13. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteoarthrosis. Ann Rheum Dis 16:494–502

    Article  PubMed  CAS  Google Scholar 

  14. Dye SF (2004) Reflections on patellofemoral disorders. In: Biedert RM (ed) Patellofemoral disorders. Diagnosis and treatment. Wiley, West Sussex, pp 3–18

    Google Scholar 

  15. Nunes GS, Stapait EL, Kirsten MH et al (2013) Clinical test for diagnosis of patellofemoral pain syndrome: systematic review with meta-analysis. Phys Ther Sport 14:54–59

    Article  PubMed  Google Scholar 

  16. Sanchis-Alfonso V, Rosello-Sastre E, Monteagudo-Castro C, Esquerdo J (2000) Quantitative analysis for neuralmarkers of the lateral retinaculum in patients with isolated symptomatic patellofemoral malalignment. A neuroanatomical basis for anterior knee pain in the active young patient. Am J Sports Med 28:725–731

    PubMed  CAS  Google Scholar 

  17. Springorum HR, Keshmiri A, Heers G et al (2012) Radiological findings, evaluation and treatment of patellofemoral pain after total knee arthroplasty. Radiologe 52:987–993

    Article  PubMed  Google Scholar 

  18. Dye SF, Vaupel GL, Dye CC (1998) Conscious neurosensory mapping of the internal structures of the human knee without intra-articular ansthesia. Am J Sports Med 26:773–777

    PubMed  CAS  Google Scholar 

  19. Tompkins M, Arendt EA (2012) Complications in patellofemoral surgery. Sports Med Arthrosc 20:187–193

    Article  PubMed  Google Scholar 

  20. Simank HG, Graf J, Kerber A et al (1997) Long term effects of core decompression by drilling. Demonstration of bone healing and vessel ingrowth in an animal study. Acta Anat (Basel) 158:185–191

    Article  CAS  Google Scholar 

  21. Biedert RM, Strauffer E, Friederich NF (1992) Occurrence of free nerve endings in the soft tissue of the knee joint. A histological investigation. Am J Sports Med 20:430–433

    Article  PubMed  CAS  Google Scholar 

  22. Rodriguez-Merchan EC (2012) Regeneration of articular cartilage of the knee. Rheumatol Int. doi:10.1007/s00296-012-2601-3

    PubMed  Google Scholar 

  23. Wojtys EM, Beaman DN, Guner RA, Janda D (1990) Innervation of the human knee joint by substance-P fibers. Arthroscopy 6:254–263

    Article  PubMed  CAS  Google Scholar 

  24. Pilling RW, Moulder E, Allgar V et al (2012) Patellar resurfacing in primary total knee replacement; a meta-analysis. J Bone Joint Surg Am 19:2270–2278

    Article  Google Scholar 

  25. Nizard RS, Biau D, Porcher R, Ravaud P, Bizot P, Hannouche D, Sedel L (2005) A meta-analysis of patellar replacement in total knee arthroplasty. Clin Orthop Relat Res 432:196–203

    Article  PubMed  Google Scholar 

  26. Pakos EE, Ntzani EE, Trikalinos TA (2005) Patellar resurfacing in total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 75:674–681

    Google Scholar 

  27. Schneider U, Graf J, Thomsen M et al (1997) Patellares Hypertensions syndrome—Nomenklatur, Diagnostik und Therpaie. Z Orhop Ijre Grenzgeb 135:70–75

    Article  CAS  Google Scholar 

  28. Fern ED, Winson IG, Getty CJ (1992) Anterior knee in rheumatoid patients after total knee arthroplasty. J Bone Joint Surg Br 74B:745–748

    Google Scholar 

  29. Waters TS, Bentley G (2003) Patellar resurfacing in total knee arthroplasty: a prospective randomized study. J Bone Joint Surg Am 85:212–217

    PubMed  Google Scholar 

  30. Barrack RL, Berton AJ, Wolfe MW, Waldman DA, Milicic M, Myers L (2001) Patellar resurfacing in total knee arthroplasty. J Bone Joint Surg Am 83-A(9):1376–1381

    PubMed  CAS  Google Scholar 

  31. Muoneke HE, Khan AM, Giannikas KA, Hagglund E, Dunningham TH (2003) Secondary resurfacing of the patella for persistent anterior knee pain after parimary knee arthroplasty. J Bone Joint Surg Br 85(5):675–678

    PubMed  CAS  Google Scholar 

  32. Park SJ, Jung YB, Jeong HJ et al (2010) Long-term results of primary total knee arthroplasty with and without patellar resurfacing. Acta Med Okayama 64(5):331–338

    PubMed  Google Scholar 

  33. Gildone A, Manfredini M, Biscione R, Faccini R (2005) Patella resurfacing in posterior stabilised total knee arthroplasty : a follow-up study in 56 patients. Acta Orthop Belg 71(4):445–451

    PubMed  Google Scholar 

  34. Oztuna V, Karatosun V, Unver B, Ayan I, Kuyurtar F (2007) An alternative patellar resurfacing technique in knee replacement: patellofemoral fascial interposition arthroplasty. Knee Surg Sports Traumatol Arthrosc 15:1210–1214

    Article  PubMed  Google Scholar 

  35. Kulkarni SK, Freeman MA, Poal-Manresa JC, Asencio JI, Rodriguez JJ (2000) The patellofemoral joint in total knee arthroplasty is the design of the trochlea the critical factor? J Arthroplasty 15(4):424–429

    Article  PubMed  CAS  Google Scholar 

  36. Oh IS, Kim MK, You DS, Kang SB, Lee KH (2006) Total knee arthroplasty without patellar resurfacing. Int Orthop 30:415–419

    Article  PubMed  Google Scholar 

  37. Shih HN, Shih LY, Wong YC, Hsu RW (2004) Long-term changes of the nonresurfaced patella after total knee arthroplasty. J Bone Joint Surg Am 86-A(5):935–939

    PubMed  Google Scholar 

Download references

Conflict of interest

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jung-Hwan Son.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, G.W., Lee, SM., Jang, SJ. et al. The efficacy of patellar decompression for improving anterior knee pain following total knee arthroplasty without patellar resurfacing. Arch Orthop Trauma Surg 133, 561–567 (2013). https://doi.org/10.1007/s00402-013-1702-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-013-1702-0

Keywords

Navigation