Short-term improvement of patellofemoral pain in medial unicompartmental knee arthroplasty with patellar denervation: a prospective comparative study

Abstract

Introduction

Medial osteoarthritis (OA) knees with symptomatic patellofemoral (PF) arthritis were not recommended for UKA in the past. However, UKA has shown good clinical results in patients with medial OA knee with symptomatic PF arthritis. On the contrary, this procedure is not recommended for patients with severe PF OA. Patella denervation (PD) by circumferential electrocautery can reduce the severity and incidence of anterior knee pain in TKA. However, to the best of our knowledge, there are no studies reporting anterior knee pain and complications of medial UKA with PD in severe PF OA.

Objective

We have conducted a prospective comparative study to assess the short-term results of anterior knee pain and complications after medial UKA with PD or without PD in medial compartment arthritis and severe PF arthritis patients.

Material and methods

This prospective comparative study was conducted from January 2018–September 2019 at Pranungkaew Hospital, Nonthaburi, Thailand. A total of 66 patients with medial compartment and severe patellofemoral arthritis were allocated to UKA with or without patella denervation. The primary outcomes were Kujala anterior knee pain scale and complications measured at 6 months after the surgery.

Results

Sixty-six patients (37 patients undergoing UKA with PD and 27 patients undergoing UKA without PD) of medial compartment and severe lateral facet patellofemoral arthritis (62 female, 4 male; mean age 60.16 (5.03) years; 17 PF grade III, 49 PF grade IV) were included in this study. The mean preoperative Kujala scores were 54.96 (range 30–80) (SD 2.59) in the no-PD group (group I) and 47.77 (range 27–75) (1.62) in the PD group (group II), respectively (p value = 0.009). All baseline characteristics were also comparable between treatment groups except the preoperative Kujala score. The mean final value of Kujala score was 70.22 (range 50–96) (2.40) in the no-PD group (group I) and 80.10 (range 60–95) (SD 1.50) in the PD group (group II), respectively (p value < 0.001). The mean difference of Kujala score was statistically significantly higher by 9.88 (4.48, 15.28) points in the PD group when compared to the no-PD group. There were no complications in both groups after surgery.

Conclusions

Patellar denervation seems to provide short-term benefits improving the Kujala score in patients with PF OA undergoing UKA.

Level of evidence

III.

Trial Registration ClinicalTrials.gov: NCT03676179

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

Fig. 1
Fig. 2

References

  1. 1.

    Berger RA, Meneghini RM, Sheinkop MB, Della Valle CJ, Jacobs JJ, Rosenberg AG, Galante JO (2004) The progression of patellofemoral arthrosis after medial unicompartmental replacement: results at 11 to 15 years. Clin Orthop Relat Res 428:92–99

    Article  Google Scholar 

  2. 2.

    Murray DW, Goodfellow JW, O'Connor JJ (1998) The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg Br 80(6):983–989

    CAS  Article  Google Scholar 

  3. 3.

    O'Rourke MR, Gardner JJ, Callaghan JJ, Liu SS, Goetz DD, Vittetoe DA, Sullivan PM, Johnston RC (2005) The John Insall Award: unicompartmental knee replacement: a minimum twenty-one-year followup, end-result study. Clin Orthop Relat Res 440:27–37

    Article  Google Scholar 

  4. 4.

    Pandit H, Jenkins C, Barker K, Dodd CA, Murray DW (2006) The Oxford medial unicompartmental knee replacement using a minimally-invasive approach. J Bone Joint Surg Br 88(1):54–60

    CAS  Article  Google Scholar 

  5. 5.

    Price AJ, Waite JC, Svard U (2005) Long-term clinical results of the medial Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res 435:171–180

    Article  Google Scholar 

  6. 6.

    Jahromi I, Walton NP, Dobson PJ, Lewis PL, Campbell DG (2004) Patient-perceived outcome measures following unicompartmental knee arthroplasty with mini-incision. Int Orthop 28(5):286–289

    CAS  Article  Google Scholar 

  7. 7.

    Jeer PJ, Cossey AJ, Keene GC (2005) Haemoglobin levels following unicompartmental knee arthroplasty: influence of transfusion practice and surgical approach. Knee 12(5):358–361

    Article  Google Scholar 

  8. 8.

    Pietschmann MF, Wohlleb L, Weber P, Schmidutz F, Ficklscherer A, Gulecyuz MF, Safi E, Niethammer TR, Jansson V, Muller PE (2013) Sports activities after medial unicompartmental knee arthroplasty Oxford III-what can we expect? Int Orthop 37(1):31–37

    Article  Google Scholar 

  9. 9.

    Pongcharoen B, Reutiwarangkoon C (2016) The comparison of anterior knee pain in severe and non severe arthritis of the lateral facet of the patella following a mobile bearing unicompartmental knee arthroplasty. SpringerPlus 5:202

    Article  Google Scholar 

  10. 10.

    Saragaglia D, Estour G, Nemer C, Colle PE (2009) Revision of 33 unicompartmental knee prostheses using total knee arthroplasty: strategy and results. Int Orthop 33(4):969–974

    Article  Google Scholar 

  11. 11.

    Ackroyd CE, Whitehouse SL, Newman JH, Joslin CC (2002) A comparative study of the medial St Georg sled and kinematic total knee arthroplasties. Ten-year survivorship. J Bone Joint Surg Br 84(5):667–672. https://doi.org/10.1302/0301-620x.84b5.12404

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Argenson JN, Chevrol-Benkeddache Y, Aubaniac JM (2002) Modern unicompartmental knee arthroplasty with cement: a three to ten-year follow-up study. J Bone Joint Surg Am 84(12):2235–2239

    Article  Google Scholar 

  13. 13.

    Pennington DW, Swienckowski JJ, Lutes WB, Drake GN (2003) Unicompartmental knee arthroplasty in patients sixty years of age or younger. J Bone Joint Surg Am 85(10):1968–1973. https://doi.org/10.2106/00004623-200310000-00016

    Article  PubMed  Google Scholar 

  14. 14.

    Squire MW, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC (1999) Unicompartmental knee replacement. A minimum 15 year followup study. Clin Orthop Relat Res 367:61–72

    Article  Google Scholar 

  15. 15.

    Svard UC, Price AJ (2001) Oxford medial unicompartmental knee arthroplasty. A survival analysis of an independent series. J Bone Joint Surg Br 83(2):191–194. https://doi.org/10.1302/0301-620x.83b2.10966

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Citak M, Cross MB, Gehrke T, Dersch K, Kendoff D (2015) Modes of failure and revision of failed lateral unicompartmental knee arthroplasties. Knee 22(4):338–340. https://doi.org/10.1016/j.knee.2015.03.008

    Article  PubMed  Google Scholar 

  17. 17.

    Xing Z, Katz J, Jiranek W (2012) Unicompartmental knee arthroplasty: factors influencing the outcome. J Knee Surg 25(5):369–373. https://doi.org/10.1055/s-0031-1299666

    Article  PubMed  Google Scholar 

  18. 18.

    Beard DJ, Pandit H, Gill HS, Hollinghurst D, Dodd CA, Murray DW (2007) The influence of the presence and severity of pre-existing patellofemoral degenerative changes on the outcome of the Oxford medial unicompartmental knee replacement. J Bone Joint Surg Br 89(12):1597–1601

    CAS  Article  Google Scholar 

  19. 19.

    Kang SN, Smith TO, Sprenger De Rover WB, Walton NP (2011) Pre-operative patellofemoral degenerative changes do not affect the outcome after medial Oxford unicompartmental knee replacement: a report from an independent centre. J Bone Joint Surg Br 93(4):476–478

    CAS  Article  Google Scholar 

  20. 20.

    Kozinn SC, Scott R (1989) Unicondylar knee arthroplasty. J Bone Joint Surg Am 71(1):145–150

    CAS  Article  Google Scholar 

  21. 21.

    Song EK, Park JK, Park CH, Kim MC, Agrawal PR, Seon JK (2016) No difference in anterior knee pain after medial unicompartmental knee arthroplasty in patients with or without patellofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 24(1):208–213

    Article  Google Scholar 

  22. 22.

    Dye SF (2005) The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res 436:100–110. https://doi.org/10.1097/01.blo.0000172303.74414.7d

    Article  Google Scholar 

  23. 23.

    Xie X, Pei F, Huang Z, Tan Z, Yang Z, Kang P (2015) Does patellar denervation reduce post-operative anterior knee pain after total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc Off J ESSKA 23(6):1808–1815. https://doi.org/10.1007/s00167-015-3566-z

    Article  Google Scholar 

  24. 24.

    Martens M, De Rycke J (1990) Facetectomy of the patella in patellofemoral osteoarthritis. Acta Orthop Belg 56(3–4):563–567

    CAS  PubMed  Google Scholar 

  25. 25.

    Yercan HS, Ait Si Selmi T, Neyret P (2005) The treatment of patellofemoral osteoarthritis with partial lateral facetectomy. Clin Orthop Relat Res 436:14–19

    Article  Google Scholar 

  26. 26.

    Wood DJ, Smith AJ, Collopy D, White B, Brankov B, Bulsara MK (2002) Patellar resurfacing in total knee arthroplasty: a prospective, randomized trial. J Bone Joint Surg Am 84-a(2):187–193

    Article  Google Scholar 

  27. 27.

    Iwano T, Kurosawa H, Tokuyama H, Hoshikawa Y (1990) Roentgenographic and clinical findings of patellofemoral osteoarthrosis. With special reference to its relationship to femorotibial osteoarthrosis and etiologic factors. Clin Orthop Relat Res 252:190–197

    Google Scholar 

  28. 28.

    Mousinho R, Ribeiro JNA, Pedrosa FKS, Lima DA, Goncalves RK, Leite JAD (2019) Evaluation of the reproducibility of the Dejour classification for femoropatellar instability. Rev Bras Ortop 54(2):171–177. https://doi.org/10.1016/j.rbo.2017.11.003

    Article  Google Scholar 

  29. 29.

    Tigchelaar S, Rooy J, Hannink G, Koeter S, van Kampen A, Bongers E (2016) Radiological characteristics of the knee joint in nail patella syndrome. Bone Joint J 98-b(4):483–489. https://doi.org/10.1302/0301-620x.98b4.37025

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Negahban H, Mostafaee N, Sohani SM, Hessam M, Tabesh H, Montazeri A (2015) Responsiveness and minimally important differences for selected Persian-version of outcome measures used in patients with patellofemoral pain syndrome. Disabil Rehabil 37(14):1285–1290

    Article  Google Scholar 

  31. 31.

    StataCorp (2017) Stata statistical software: release 15. StataCorp LLC, College Station, TX

    Google Scholar 

  32. 32.

    Liu ZT, Fu PL, Wu HS, Zhu Y (2012) Patellar reshaping versus resurfacing in total knee arthroplasty—results of a randomized prospective trial at a minimum of 7 years' follow-up. Knee 19(3):198–202

    CAS  Article  Google Scholar 

  33. 33.

    Beard DJ, Pandit H, Ostlere S, Jenkins C, Dodd CA, Murray DW (2007) Pre-operative clinical and radiological assessment of the patellofemoral joint in unicompartmental knee replacement and its influence on outcome. J Bone Joint Surg Br 89(12):1602–1607

    CAS  Article  Google Scholar 

  34. 34.

    Horner G, Dellon AL (1994) Innervation of the human knee joint and implications for surgery. Clin Orthop Relat Res 301:221–226

    Google Scholar 

  35. 35.

    Maralcan G, Kuru I, Issi S, Esmer AF, Tekdemir I, Evcik D (2005) The innervation of patella: anatomical and clinical study. Surg Radiol Anat SRA 27(4):331–335

    CAS  Article  Google Scholar 

  36. 36.

    Altay MA, Erturk C, Altay N, Akmese R, Isikan UE (2012) Patellar denervation in total knee arthroplasty without patellar resurfacing: a prospective, randomized controlled study. Orthop Traumatol Surg Res OTSR 98(4):421–425

    CAS  Article  Google Scholar 

  37. 37.

    Knight JL, Atwater RD, Guo J (1997) Early failure of the porous coated anatomic cemented unicompartmental knee arthroplasty. Aids to diagnosis and revision. J Arthroplast 12(1):11–20. https://doi.org/10.1016/s0883-5403(97)90041-3

    CAS  Article  Google Scholar 

  38. 38.

    Scott CEH, Wade FA, MacDonald D, Nutton RW (2018) Ten-year survival and patient-reported outcomes of a medial unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component. Arch Orthop Trauma Surg 138(5):719–729. https://doi.org/10.1007/s00402-018-2908-y

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

All authors declare no funding source or sponsor involvement in the study design, collection, analysis and interpretation of the data, in writing the manuscript, and in submission of the manuscript for publication

Funding

This study has no funding support.

Author information

Affiliations

Authors

Corresponding author

Correspondence to J. Kongtharvonskul.

Ethics declarations

Conflict of interest

All authors declare that they have no conflicts of interests.

Ethical approval

This study was approved by the Human Research Ethics Committee of RSB, Pranungkaew Hospital, and the protocol (ID: 08/2561).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Suwankomonkul, P., Arirachakaran, A. & Kongtharvonskul, J. Short-term improvement of patellofemoral pain in medial unicompartmental knee arthroplasty with patellar denervation: a prospective comparative study. Musculoskelet Surg (2020). https://doi.org/10.1007/s12306-020-00675-7

Download citation

Keywords

  • UKA
  • Patella denervation
  • Circumferential electrocautery
  • Kujala
  • Complication