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Patellar denervation does not reduce post-operative anterior knee pain after primary total knee arthroplasty with patellar resurfacing

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Anterior knee pain (AKP) is a frequent symptom after a total knee arthroplasty (TKA). Patellar denervation (PD) has been put forth as a technique to reduce this pain; however, its effects have not been assessed in combination with patellar resurfacing. The aim of this study is to evaluate the effect of PD on AKP and functional outcomes after TKA with patellar resurfacing.

Methods

A prospective study was designed that included patients scheduled for TKA with patellar resurfacing. The 202 recruited patients were randomized into either the PD group or the non-denervation group [mean age 72.7 years (SD 8.2); 119 (70.4%) women and 50 (29.6%) men; average body mass index 31.4 kg/m2 (SD 4.9)]. Pressure pain threshold (PPT) assessed by pressure algometry (PA), visual analogue scale(VAS), patellofemoral Feller score and the Knee Society Scores (KSS) were recorded preoperatively and at the 1-year follow-up.

Results

169 patients were included in data analysis. At the 1-year follow-up, there were mild differences between denervation and non-denervation group in PPT value (494.4 kPa vs. 552.3 kPa, p = 0.047) and in VAS at stairs (2.9 vs. 1.5, p = 0.003) in favour of the non-denervation group. There was no difference in the improvement between groups in patellofemoral Feller score and KSS, but slightly higher improvement in non-denervation group in PPT (94.1 kPa vs. 160 kPa, p = 0.047), VAS walking (5.3 vs. 6.2, p = 0.041) and VAS at stairs (4.6 vs. 5.7, p = 0.022).

Conclusion

Patellar denervation does not improve AKP and clinical outcomes in primary TKA with patellar resurfacing compared to patellar replacement without denervation. PD cannot be recommended when patellar replacement is performed in TKA.

Level of evidence

II.

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Abbreviations

AKP:

Anterior knee pain

TKA:

Total knee arthroplasty

PD:

Patellar denervation

PTT:

Pressure pain threshold

PA:

Pressure algometry

VAS:

Visual analogue scale

KSS:

Knee society score

PFS:

Patellofemoral feller score

SD:

Standard deviation

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Acknowledgements

The authors would like to thank Xavier Duran for his assistance in the statistical analysis. This study has been carried out within the framework of the Doctorate in Surgery and Morphological Sciences of the Universitat Autònoma de Barcelona.

Funding

The authors received no financial support for the research, authorship, and publication of this article.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain

    Nerea Goicoechea, Pedro Hinarejos, Raul Torres-Claramunt, Joan Leal-Blanquet, Juan Sánchez-Soler & Joan Carles Monllau

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  1. Nerea Goicoechea
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  2. Pedro Hinarejos
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  3. Raul Torres-Claramunt
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  6. Joan Carles Monllau
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Correspondence to Nerea Goicoechea.

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The study was approved by the Research Ethics Committee of our institution (2017/7192/I).

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Written informed consent was obtained from all the participants included.

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Goicoechea, N., Hinarejos, P., Torres-Claramunt, R. et al. Patellar denervation does not reduce post-operative anterior knee pain after primary total knee arthroplasty with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 29, 3346–3351 (2021). https://doi.org/10.1007/s00167-020-06164-5

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