Archives of Orthopaedic and Trauma Surgery

, Volume 133, Issue 4, pp 561–567 | Cite as

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

  • Gun Woo Lee
  • Sun-Mi Lee
  • Soo-Jin Jang
  • Jung-Hwan Son
Knee Arthroplasty
First Online:
Received:

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.

Keywords

Anterior knee pain Patellar decompression Total knee arthroplasty 
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Notes

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.

References

  1. 1.
    Ghomrawi HM, Schackman BR, Mushlin AI (2012) Appropriateness criteria and elective procedures—total joint arthroplasty. N Engl J Med 367:2467–2469PubMedCrossRefGoogle Scholar
  2. 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 94:134–136PubMedGoogle Scholar
  3. 3.
    Richmond JC (2013) Surgery for osteoarthritis of the knee. Rheum Dis Clin North Am 39:203–211PubMedCrossRefGoogle Scholar
  4. 4.
    Kim YM, Joo YB (2012) Patellofemoral osteoarthritis. Knee Surg Relat Res 24:193–200PubMedCrossRefGoogle Scholar
  5. 5.
    Dye SF (2001) Patellofemoral pain current concept: an overview. Sports Med Arthroscopy Rev 9:306–311CrossRefGoogle Scholar
  6. 6.
    Arnold CC, Lemperg RK, Linderholm H (1975) Intraosseous hypertension and pain in the knee. J Bone Joint Surg Br 57:360–363Google Scholar
  7. 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 PubMedGoogle Scholar
  8. 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 23:581–586PubMedGoogle Scholar
  9. 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 130:191–196PubMedCrossRefGoogle Scholar
  10. 10.
    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop 248:13–14PubMedGoogle Scholar
  11. 11.
    Aichroth P, Freeman MAR, Smillie IS, Souter WA (1978) A knee function assessment chart. J Bone Joint Surg Br 60:308–309Google Scholar
  12. 12.
    Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop 248:9–12PubMedGoogle Scholar
  13. 13.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteoarthrosis. Ann Rheum Dis 16:494–502PubMedCrossRefGoogle Scholar
  14. 14.
    Dye SF (2004) Reflections on patellofemoral disorders. In: Biedert RM (ed) Patellofemoral disorders. Diagnosis and treatment. Wiley, West Sussex, pp 3–18Google Scholar
  15. 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 14:54–59PubMedCrossRefGoogle Scholar
  16. 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 28:725–731PubMedGoogle Scholar
  17. 17.
    Springorum HR, Keshmiri A, Heers G et al (2012) Radiological findings, evaluation and treatment of patellofemoral pain after total knee arthroplasty. Radiologe 52:987–993PubMedCrossRefGoogle Scholar
  18. 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 26:773–777PubMedGoogle Scholar
  19. 19.
    Tompkins M, Arendt EA (2012) Complications in patellofemoral surgery. Sports Med Arthrosc 20:187–193PubMedCrossRefGoogle Scholar
  20. 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) 158:185–191CrossRefGoogle Scholar
  21. 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 20:430–433PubMedCrossRefGoogle Scholar
  22. 22.
    Rodriguez-Merchan EC (2012) Regeneration of articular cartilage of the knee. Rheumatol Int. doi: 10.1007/s00296-012-2601-3 PubMedGoogle Scholar
  23. 23.
    Wojtys EM, Beaman DN, Guner RA, Janda D (1990) Innervation of the human knee joint by substance-P fibers. Arthroscopy 6:254–263PubMedCrossRefGoogle Scholar
  24. 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 19:2270–2278CrossRefGoogle Scholar
  25. 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 432:196–203PubMedCrossRefGoogle Scholar
  26. 26.
    Pakos EE, Ntzani EE, Trikalinos TA (2005) Patellar resurfacing in total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 75:674–681Google Scholar
  27. 27.
    Schneider U, Graf J, Thomsen M et al (1997) Patellares Hypertensions syndrome—Nomenklatur, Diagnostik und Therpaie. Z Orhop Ijre Grenzgeb 135:70–75CrossRefGoogle Scholar
  28. 28.
    Fern ED, Winson IG, Getty CJ (1992) Anterior knee in rheumatoid patients after total knee arthroplasty. J Bone Joint Surg Br 74B:745–748Google Scholar
  29. 29.
    Waters TS, Bentley G (2003) Patellar resurfacing in total knee arthroplasty: a prospective randomized study. J Bone Joint Surg Am 85:212–217PubMedGoogle Scholar
  30. 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):1376–1381PubMedGoogle Scholar
  31. 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):675–678PubMedGoogle Scholar
  32. 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):331–338PubMedGoogle Scholar
  33. 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):445–451PubMedGoogle Scholar
  34. 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 15:1210–1214PubMedCrossRefGoogle Scholar
  35. 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):424–429PubMedCrossRefGoogle Scholar
  36. 36.
    Oh IS, Kim MK, You DS, Kang SB, Lee KH (2006) Total knee arthroplasty without patellar resurfacing. Int Orthop 30:415–419PubMedCrossRefGoogle Scholar
  37. 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):935–939PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Gun Woo Lee
    • 1
  • Sun-Mi Lee
    • 2
  • Soo-Jin Jang
    • 3
  • Jung-Hwan Son
    • 3
  1. 1.Spine Center and Department of Orthopaedic SurgerySeoul National University College of Medicine and Seoul National University Bundang HospitalSungnamRepublic of Korea
  2. 2.Department of Family MedicineDong-A University College of MedicineBusanRepublic of Korea
  3. 3.Department of Orthopaedic SurgeryKosin University Gospel HospitalBusanRepublic of Korea

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