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Patellofemoral resurfacing and patellar denervation in primary total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To conduct a systematic review and network meta-analysis of randomized controlled trials (RCTs) with the aim of comparing relevant clinical outcomes between patellar denervation, resurfacing and non-resurfacing.

Methods

A database search was performed using PubMed and Scopus search engines. RCTs or quasi-experimental designs comparing clinical outcomes between treatments by a search of articles dated from inception to October 23, 2012. Unstandardized mean difference (UMD) and random effects methods were applied for pooling continuous and dichotomous outcomes, respectively. A longitudinal mixed regression model was used for network meta-analysis to indirectly compare treatment effects.

Results

Eighteen of 315 studies identified were eligible. Compared with patellar non-resurfacing, patellar denervation had a UMD that displayed a significant improvement in symptoms with values in pain visual analog score (VAS) and Knee Society Score (KSS) of −0.6 [95 % confidence interval (CI) −1.13, −0.25] and 2.55 (95 % CI 0.43, 4.68), respectively. The UMD in VAS, KSS, and Knee Function Score (KFS) in patellar resurfacing showed no significant improvement in symptoms when compared to non-resurfacing. Patients who underwent surgery with patellar resurfacing had a lower reoperation rates with pooled relative risks (RRs) of 0.69 (95 % CI 0.50, 0.94) when compared to non-resurfacing. The network meta-analysis suggested a benefit of borderline significance for patellar denervation with a pooled RR of 0.63 (95 % CI 0.38, 1.03), showing that there is a lower chance of anterior knee pain when compared to non-resurfacing. Patellar resurfacing also displays a significantly lower chance of reoperation with a pooled RR of 0.68 (95 % CI 0.50, 0.92) when compared to non-resurfacing. Multiple active treatment comparisons indicated that patellar denervation resulted in greater improvement in KFS than patellar resurfacing.

Conclusion

This review suggests that either patellar denervation or patellar resurfacing may be selected for the management of the patellofemoral component in total knee replacement. Patellar denervation may help improve postoperative knee function, but does not improve pain when compared to patellar resurfacing.

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Conflict of interest

All authors declare that they have no conflict of interests.

Author information

Authors and Affiliations

  1. Orthopedics Department, Police General Hospital, Bangkok, Thailand

    Alisara Arirachakaran & Chanchit Sangkaew

  2. Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand

    Jatupon Kongtharvonskul

Authors
  1. Alisara Arirachakaran
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  2. Chanchit Sangkaew
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  3. Jatupon Kongtharvonskul
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Corresponding author

Correspondence to Jatupon Kongtharvonskul.

Appendix

Appendix

Search term

#1 total knee arthroplasty

#2 patella resurfacing

#3 patella denervation

#4 patella non-resurfacing

#5 #2 or #3 or #4

#6 anterior knee pain

#7 AKP

#8 KSS

#9 Knee Society Score

#10 Knee Function Score

#11 WOMAC Score

#12 Bristol Score

#13 PF problem

#14 reoperation

#15 #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14

# 16 clinical trial OR RCT OR randomize controlled trial

#17 #1 and #5 and #15 and #16

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Arirachakaran, A., Sangkaew, C. & Kongtharvonskul, J. Patellofemoral resurfacing and patellar denervation in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23, 1770–1781 (2015). https://doi.org/10.1007/s00167-014-3311-z

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  • DOI: https://doi.org/10.1007/s00167-014-3311-z

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