Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2011

01-09-2011 | Knee

Anterior knee pain after total knee arthroplasty: does it correlate with patellar blood flow?

Authors: Sandro Kohl, Dimitrios S. Evangelopoulos, Maximilian Hartel, Hendrik Kohlhof, Christoph Roeder, Stefan Eggli

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2011

Login to get access

Abstract

Purpose

Total knee arthroplasty (TKA) disturbs patellar blood flow, an unintended accompaniment to TKA that may be a cause of postoperative anterior knee pain. We examine whether disrupted patellar blood flow correlates with anterior knee pain following TKA.

Methods

In 50 patients (21 men, 29 women) undergoing TKA, we compared patellar blood flow at flexions 0° to 30°, 60°, 90°, and 110° before and after medial parapatellar arthrotomy to pre- and postoperative anterior knee pain scores by means of a laser Doppler flowmeter (LDF) probe. Anterior knee pain was assessed using the pain intensity numeric rating scale (NRS) of 0–10 (0-no, 10-worst pain). Based on the NRS pain values, patients were divided into two main groups: group A (n = 34) with no pain or discomfort (NRS range 0–4) and group B (n = 16) with anterior knee pain (NRS range 5–10).

Results

Patients of group B demonstrated a significant decrease in blood flow before arthrotomy at flexions from 0° to 90°, and 110° and from 0° to 60°, 90°, and 110° after arthrotomy. For group A, a significant decrease in blood flow was detected at flexions from 0° to 90°, and 110° before and after arthrotomy. For both groups, medial arthrotomy did not have a statistically significant influence on patellar blood flow (margin of significance P < 0.05). Prior to TKA, 16 of the 50 patients of group B (32%) complained of anterior knee pain (mean NRS 7.1 ± 1.7). At 2-year follow-up, pain significantly decreased (NRS 3.1 ± 2.1) and only 4 of the 16 patients (25%) complained of moderate anterior pain (average NRS 5.7 ± 0.5), while 8 of 16 (50%) patients reported discomfort (mean NRS 3.5 ± 1.8) around the patella. Patients in group A also demonstrated a significant decrease in pain intensity (from NRS 1.5 ± 1.4 preoperatively to NRS 0.4 ± 1.5 at 2-year follow-up). Statistical analysis demonstrated no statistically significant correlation between pre-arthrotomy/post-arthrotomy patellar blood flow and the presence of preoperative and postoperative anterior knee pain. Only the degree of flexion had an influence on patellar blood flow.

Conclusion

Medial arthrotomy had no direct significant effect on patellar blood flow, and the diminished blood flow did not correlate with postoperative anterior knee pain. However, a significant correlation was revealed between patellar blood flow and the degree of flexion: in almost a quarter of patients, blood flow dropped to zero at flexions of 100° and above.

Level of evidence

II.
Literature
1.
go back to reference Ahmad R, Kumar GS, Katam K et al (2009) Significance of a “hot patella” in total knee replacement without primary patellar resurfacing. Knee 16:337–340PubMedCrossRef Ahmad R, Kumar GS, Katam K et al (2009) Significance of a “hot patella” in total knee replacement without primary patellar resurfacing. Knee 16:337–340PubMedCrossRef
2.
go back to reference Bäthis H, Perlick L, Blum C et al (2005) Midvastus approach in total knee arthroplasty: a randomized, double-blinded study on early rehabilitation. Knee Surg Sports Traumatol Arthrosc 13:545–550PubMedCrossRef Bäthis H, Perlick L, Blum C et al (2005) Midvastus approach in total knee arthroplasty: a randomized, double-blinded study on early rehabilitation. Knee Surg Sports Traumatol Arthrosc 13:545–550PubMedCrossRef
3.
go back to reference Berth A, Urbach D, Neumann W et al (2007) Strength and voluntary activation of quadriceps femoris muscle in total knee arthroplasty with midvastus and subvastus approaches. J Arthroplasty 22:83–88PubMedCrossRef Berth A, Urbach D, Neumann W et al (2007) Strength and voluntary activation of quadriceps femoris muscle in total knee arthroplasty with midvastus and subvastus approaches. J Arthroplasty 22:83–88PubMedCrossRef
4.
go back to reference Bonutti PM, Miller BG, Cremens MJ (1998) Intraosseous patellar blood supply after medial parapatellar arthrotomy. Clin Orthop Relat Res 352:202–214PubMedCrossRef Bonutti PM, Miller BG, Cremens MJ (1998) Intraosseous patellar blood supply after medial parapatellar arthrotomy. Clin Orthop Relat Res 352:202–214PubMedCrossRef
5.
go back to reference Brick GW, Scott RD (1989) Blood supply to the patella. Significance in total knee arthroplasty. J Arthroplasty 4:S75–S79PubMedCrossRef Brick GW, Scott RD (1989) Blood supply to the patella. Significance in total knee arthroplasty. J Arthroplasty 4:S75–S79PubMedCrossRef
6.
go back to reference Burnet RS, Haydon CM, Rorabeck CH et al (2004) Patella resurfacing versus nonresurfacing in total knee arthroplasty. Results of a randomized controlled clinical trial at a minimum of 10 years’ followup. Clin Orthop Relat Res 428:12–25CrossRef Burnet RS, Haydon CM, Rorabeck CH et al (2004) Patella resurfacing versus nonresurfacing in total knee arthroplasty. Results of a randomized controlled clinical trial at a minimum of 10 years’ followup. Clin Orthop Relat Res 428:12–25CrossRef
7.
go back to reference Burnett RS, Boone JL, McCarthy KP (2007) A prospective randomized clinical trial of patellar resurfacing and non resurfacing in bilateral TKA. Clin Orthop Relat Res 464:65–72PubMed Burnett RS, Boone JL, McCarthy KP (2007) A prospective randomized clinical trial of patellar resurfacing and non resurfacing in bilateral TKA. Clin Orthop Relat Res 464:65–72PubMed
8.
go back to reference Eisenhuth SA, Saleh KJ, Cui Q et al (2006) Patellofemoral instability after total knee arthroplasty. Clin Orthop Relat Res 446:149–160PubMedCrossRef Eisenhuth SA, Saleh KJ, Cui Q et al (2006) Patellofemoral instability after total knee arthroplasty. Clin Orthop Relat Res 446:149–160PubMedCrossRef
9.
go back to reference Gelfer Y, Pinkas L, Horne T et al (2003) Symptomatic transient patellar ischemia following total knee replacement as detected by scintigraphy. A prospective, randomized, double-blind study comparing the mid-vastus to the medial para-patellar approach. Knee 10:341–345PubMedCrossRef Gelfer Y, Pinkas L, Horne T et al (2003) Symptomatic transient patellar ischemia following total knee replacement as detected by scintigraphy. A prospective, randomized, double-blind study comparing the mid-vastus to the medial para-patellar approach. Knee 10:341–345PubMedCrossRef
10.
go back to reference Hasegawa M, Kawamura G, Wakabayashi H et al (2009) Changes to patellar blood flow after minimally invasive total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17:1195–1198PubMedCrossRef Hasegawa M, Kawamura G, Wakabayashi H et al (2009) Changes to patellar blood flow after minimally invasive total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17:1195–1198PubMedCrossRef
11.
go back to reference Hempfing A, Schoeniger R, Koch PP et al (2007) Patellar blood flow during knee arthroplasty surgical exposure: Intraoperative monitoring by laser doppler flowmetry. J Orthop Res 25:1389–1394PubMedCrossRef Hempfing A, Schoeniger R, Koch PP et al (2007) Patellar blood flow during knee arthroplasty surgical exposure: Intraoperative monitoring by laser doppler flowmetry. J Orthop Res 25:1389–1394PubMedCrossRef
12.
go back to reference Hofmann AA, Plaster RL, Murdock LE (1991) Subvastus (Southern) Approach for Primary Total Knee Arthroplasty. Clin Orthop Relat Res 269:70–77PubMed Hofmann AA, Plaster RL, Murdock LE (1991) Subvastus (Southern) Approach for Primary Total Knee Arthroplasty. Clin Orthop Relat Res 269:70–77PubMed
13.
go back to reference Holt GE, Dennis DA (2003) The Role of Patellar Resurfacing in Total Knee Arthroplasty. Clin Orthop Relat Res 416:76–83PubMedCrossRef Holt GE, Dennis DA (2003) The Role of Patellar Resurfacing in Total Knee Arthroplasty. Clin Orthop Relat Res 416:76–83PubMedCrossRef
14.
go back to reference Hughes SS, Cammarata A, Steinmann SP et al (1998) Effect of standard total knee arthroplasty surgical dissection on human patellar blood flow in vivo: an investigation using laser Doppler flowmetry. J South Orthop Assoc 7:198–204PubMed Hughes SS, Cammarata A, Steinmann SP et al (1998) Effect of standard total knee arthroplasty surgical dissection on human patellar blood flow in vivo: an investigation using laser Doppler flowmetry. J South Orthop Assoc 7:198–204PubMed
15.
go back to reference Insall JN (1979) “Chondromalacia Patellae”: Patellar malalignment syndrome. Orthop Clin North Am 10:117–127PubMed Insall JN (1979) “Chondromalacia Patellae”: Patellar malalignment syndrome. Orthop Clin North Am 10:117–127PubMed
16.
go back to reference Järvelä T, Halonen P, Järvelä K et al (2005) Reconstruction of ruptured patellar tendon after total knee arthroplasty: a case report and a description of an alternative fixation method. Knee 12:139–143PubMedCrossRef Järvelä T, Halonen P, Järvelä K et al (2005) Reconstruction of ruptured patellar tendon after total knee arthroplasty: a case report and a description of an alternative fixation method. Knee 12:139–143PubMedCrossRef
17.
go back to reference Kelly MA (2001) Patellofemoral complications following total knee arthroplasty. Instr Course Lect 50:403–407PubMed Kelly MA (2001) Patellofemoral complications following total knee arthroplasty. Instr Course Lect 50:403–407PubMed
18.
go back to reference Lausten GS, Arnoldi CC (1993) Blood perfusion uneven in femoral head osteonecrosis. Doppler flowmetry and intraosseous pressure in 12 cases. Acta Orthop Scand 64:533–536PubMedCrossRef Lausten GS, Arnoldi CC (1993) Blood perfusion uneven in femoral head osteonecrosis. Doppler flowmetry and intraosseous pressure in 12 cases. Acta Orthop Scand 64:533–536PubMedCrossRef
19.
go back to reference Moor Instruments Limited, Millwey Axminster, Devon EX13 5HU, England (2002) Moor instruments DRT4 Laser Doppler blood flow monitor user manual version 4.1 (12) Moor Instruments Limited, Millwey Axminster, Devon EX13 5HU, England (2002) Moor instruments DRT4 Laser Doppler blood flow monitor user manual version 4.1 (12)
20.
go back to reference Mutsuedu M, Gustilo RB (2000) Subvastus and medial parapatellar approaches in total knee arthroplasty. Clin Orthop Relat Res 371:161–168CrossRef Mutsuedu M, Gustilo RB (2000) Subvastus and medial parapatellar approaches in total knee arthroplasty. Clin Orthop Relat Res 371:161–168CrossRef
21.
go back to reference Naeder HN, Anglin C, Greidanus NV, Masri BA et al (2008) To resurface or not to resurface the patella in total knee arthroplasty. Clin Orthop Relat Res 466:2775–2783CrossRef Naeder HN, Anglin C, Greidanus NV, Masri BA et al (2008) To resurface or not to resurface the patella in total knee arthroplasty. Clin Orthop Relat Res 466:2775–2783CrossRef
22.
go back to reference Nicholls RL, Green D, Kuster MS (2006) Patella intraosseous blood flow disturbance during a medial or lateral arthrotomy in total knee arthroplasty: a laser Doppler flowmetry study. Knee Surg Sports Traumatol Arthrosc 14:411–416PubMedCrossRef Nicholls RL, Green D, Kuster MS (2006) Patella intraosseous blood flow disturbance during a medial or lateral arthrotomy in total knee arthroplasty: a laser Doppler flowmetry study. Knee Surg Sports Traumatol Arthrosc 14:411–416PubMedCrossRef
23.
go back to reference Notzli HP, Swiontkowski MF, Thaxter ST et al (1989) Laser Doppler flowmetry for bone blood flow measurements: helium–neon laser light attenuation and depth of perfusion assessment. J Orthop Res 7:413–424PubMedCrossRef Notzli HP, Swiontkowski MF, Thaxter ST et al (1989) Laser Doppler flowmetry for bone blood flow measurements: helium–neon laser light attenuation and depth of perfusion assessment. J Orthop Res 7:413–424PubMedCrossRef
24.
go back to reference Park SS, Kubiak EN, Wasserman B et al (2005) Management of extensor mechanism disruptions occurring after total knee arthroplasty. Am J Orthop 34:365–372PubMed Park SS, Kubiak EN, Wasserman B et al (2005) Management of extensor mechanism disruptions occurring after total knee arthroplasty. Am J Orthop 34:365–372PubMed
25.
go back to reference Petersen W, Stein V, Tillmann B (1999) Blood supply of the quadriceps tendon. Unfallchirurg 102:543–547PubMedCrossRef Petersen W, Stein V, Tillmann B (1999) Blood supply of the quadriceps tendon. Unfallchirurg 102:543–547PubMedCrossRef
26.
go back to reference Pierson JL, Ritter MA, Keating EM et al (2007) The effect of stuffing the patellofemoral compartment on the outcome of total knee arthroplasty. J Bone Joint Surg Am 89:2195–2203PubMedCrossRef Pierson JL, Ritter MA, Keating EM et al (2007) The effect of stuffing the patellofemoral compartment on the outcome of total knee arthroplasty. J Bone Joint Surg Am 89:2195–2203PubMedCrossRef
27.
go back to reference Prada SA, Griffin FM, Nelson CL et al (2003) Allograft reconstruction for extensor mechanism rupture after total knee arthroplasty: 4.8-year follow-up. Orthopedics 26:1205–1208PubMed Prada SA, Griffin FM, Nelson CL et al (2003) Allograft reconstruction for extensor mechanism rupture after total knee arthroplasty: 4.8-year follow-up. Orthopedics 26:1205–1208PubMed
28.
go back to reference Sanchis-Alfonso V (2008) Patellofemoral pain. Orthopade 37(835–6):838–840 Sanchis-Alfonso V (2008) Patellofemoral pain. Orthopade 37(835–6):838–840
29.
go back to reference Sanchis-Alfonso V, Roselló-Sastre E (2003) Anterior knee pain in the young patient-what causes the pain? “Neural model”. Acta Orthop Scand 74:697–703PubMedCrossRef Sanchis-Alfonso V, Roselló-Sastre E (2003) Anterior knee pain in the young patient-what causes the pain? “Neural model”. Acta Orthop Scand 74:697–703PubMedCrossRef
30.
go back to reference Schuh A, Hönle W (2008) Pathological findings and therapy for anterior knee pain following total knee arthroplasty. Z Orthop Unfall 146:352–356PubMedCrossRef Schuh A, Hönle W (2008) Pathological findings and therapy for anterior knee pain following total knee arthroplasty. Z Orthop Unfall 146:352–356PubMedCrossRef
31.
go back to reference Scuderi GR, Insall JN, Scott NW (1994) Patellofemoral pain after total knee arthroplasty. J Am Acad Orthop Surg 2:239–246PubMed Scuderi GR, Insall JN, Scott NW (1994) Patellofemoral pain after total knee arthroplasty. J Am Acad Orthop Surg 2:239–246PubMed
32.
go back to reference Stoffel KK, Flivik G, Yates PJ et al (2007) Intraosseous blood flow of the everted or laterally-retracted patella during total knee arthroplasty. Knee 14:434–438PubMedCrossRef Stoffel KK, Flivik G, Yates PJ et al (2007) Intraosseous blood flow of the everted or laterally-retracted patella during total knee arthroplasty. Knee 14:434–438PubMedCrossRef
33.
go back to reference Swiontkowski MF, Ganz R, Schlegel U et al (1987) Laser Doppler flowmetry for clinical evaluation of femoral head osteonecrosis. Preliminary experience. Clin Orthop Relat Res 218:181–185PubMed Swiontkowski MF, Ganz R, Schlegel U et al (1987) Laser Doppler flowmetry for clinical evaluation of femoral head osteonecrosis. Preliminary experience. Clin Orthop Relat Res 218:181–185PubMed
34.
go back to reference Vega J, Golanó P, Pérez-Carro L (2006). Electrosurgical arthroscopic patellar denervation. Arthroscopy 22:1028.e1–1028.e3 Vega J, Golanó P, Pérez-Carro L (2006). Electrosurgical arthroscopic patellar denervation. Arthroscopy 22:1028.e1–1028.e3
35.
go back to reference Waters TS, Bentley G (2003) Patellar resurfacing in total knee arthroplasty. A prospective randomized study. J Bone Joint Surg Am 85:212–217PubMed Waters TS, Bentley G (2003) Patellar resurfacing in total knee arthroplasty. A prospective randomized study. J Bone Joint Surg Am 85:212–217PubMed
36.
go back to reference Weinhardt C, Barisic M, Bergmann EG et al (2004) Early results of subvastus versus medial parapatellar approach in primary total knee arthroplasty. Arch Orthop Trauma Surg 124:401–403PubMedCrossRef Weinhardt C, Barisic M, Bergmann EG et al (2004) Early results of subvastus versus medial parapatellar approach in primary total knee arthroplasty. Arch Orthop Trauma Surg 124:401–403PubMedCrossRef
Metadata
Title
Anterior knee pain after total knee arthroplasty: does it correlate with patellar blood flow?
Authors
Sandro Kohl
Dimitrios S. Evangelopoulos
Maximilian Hartel
Hendrik Kohlhof
Christoph Roeder
Stefan Eggli
Publication date
01-09-2011
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2011
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-011-1418-z

Other articles of this Issue 9/2011

Knee Surgery, Sports Traumatology, Arthroscopy 9/2011 Go to the issue