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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 11/2014

01-11-2014 | Knee

Patellar denervation with electrocautery in total knee arthroplasty without patellar resurfacing: a meta-analysis

Authors: Tao Cheng, Chen Zhu, Yongyuan Guo, Sifeng Shi, Desheng Chen, Xianlong Zhang

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2014

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Abstract

Purpose

The impact of patellar denervation with electrocautery in total knee arthroplasty (TKA) on post-operative outcomes has been under debate. This study aims to conduct a meta-analysis and systematic review to compare the benefits and risks of circumpatellar electrocautery with those of non-electrocautery in primary TKAs.

Methods

Comparative and randomized clinical studies were identified by conducting an electronic search of articles dated up to September 2012 in PubMed, EMBASE, Scopus, and the Cochrane databases. Six studies that focus on a total of 849 knees were analysed. A random-effects model was conducted using the inverse-variance method for continuous variables and the Mantel–Haenszel method for dichotomous variables.

Results

There was no significant difference in the incidence of anterior knee pain between the electrocautery and non-electrocautery groups. In term of patellar score and Knee Society Score, circumpatellar electrocautery improved clinical outcomes compared with non-electrocautery in TKAs. The statistical differences were in favour of the electrocautery group but have minimal clinical significance. In addition, the overall complications indicate no statistical significance between the two groups.

Conclusions

This study shows no strong evidence either for or against electrocautery compared with non-electrocautery in TKAs.

Level of evidence

Therapeutic study (systematic review and meta-analysis), Level III.
Literature
1.
Altay MA, Ertürk C, Altay N, Akmeşe R, Işıkan UE (2012) Patellar denervation in total knee arthroplasty without patellar resurfacing: a prospective, randomized controlled study. Orthop Traumatol Surg Res 98:421–425PubMedCrossRef
2.
Arbuthnot JE, McNicholas MJ, McGurty DW, Rowley DI (2004) Total knee replacement and patellofemoral pain. Surgeon 2:230–233PubMedCrossRef
3.
Baker PN, Petheram T, Jameson SS, Avery PJ, Reed MR, Gregg PJ (2012) Comparison of patient-reported outcome measures following total and unicondylar knee replacement. J Bone Joint Surg Br 94:919–927PubMedCrossRef
4.
Baker PN, van der Meulen JH, Lewsey J, Gregg PJ (2007) The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br 89:893–900PubMedCrossRef
5.
Baliga S, McNair CJ, Barnett KJ, MacLeod J, Humphry RW, Finlayson D (2012) Does circumpatellar electrocautery improve the outcome after total knee replacement?: a prospective, randomised, blinded controlled trial. J Bone Joint Surg Br 94:1228–1233PubMedCrossRef
6.
Barrack RL, Bertot AJ, Wolfe MW, Waldman DA, Milicic M, Myers L (2001) Patellar resurfacing in total knee arthroplasty. A prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Am 83:1376–1381PubMed
7.
Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L (2001) Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res 392:46–55PubMedCrossRef
8.
Barrack RL (2003) Orthopaedic crossfire–All patellae should be resurfaced during primary total knee arthroplasty: in opposition. J Arthroplasty 18(3 Suppl 1):35–38PubMedCrossRef
9.
Bohnsack M, Meier F, Walter GF, Hurschler C, Schmolke S, Wirth CJ (2005) Distribution of substance-P nerves inside the infrapatellar fat pad and the adjacent synovial tissue: a neurohistological approach to anterior knee pain syndrome. Arch Orthop Trauma Surg 125:592–597PubMedCrossRef
10.
Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63PubMedCrossRefPubMedCentral
11.
Breugem SJ, Sierevelt IN, Schafroth MU, Blankevoort L, Schaap GR, van Dijk CN (2008) Less anterior knee pain with a mobile-bearing prosthesis compared with a fixed-bearing prosthesis. Clin Orthop Relat Res 466:1959–1965PubMedCrossRefPubMedCentral
12.
Campbell DG, Duncan WW, Ashworth M, Mintz A, Stirling J, Wakefield L (2006) Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. J Bone Joint Surg Br 88:734–739PubMedCrossRef
13.
Daniilidis K, Voqt B, Gosheger G, Henrichs M, Dieckmann R, Schulz D (2012) Patellar resurfacing as a second stage procedure for persistent anterior knee pain after primary total knee arthroplasty. Int Orthop 36:1181–1183PubMedCrossRefPubMedCentral
14.
Deehan DJ, Phaltankar PM, Pinder IM (2008) Do we need to replace the patella in knee arthroplasty for rheumatoid disease? Acta Orthop Belg 74:478–482PubMed
15.
Di Martino A, Franceschi F, Papalia R, Marini M, Prossomariti G, Maffulli N (2012) Increased bone mineral density in the non-resurfaced patella after total knee arthroplasty: a clinical and densitometric study. Surgeon 10:20–24PubMedCrossRef
16.
Feller JA, Bartlett RJ, Lang DM (1996) Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br 78:226–228PubMed
17.
Fu Y, Wang G, Fu Q (2011) Patellar resurfacing in total knee arthroplasty for osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 19:1460–1466PubMedCrossRef
18.
Ghomrawi HM, Mandl LA, Rutledge J, Alexiades MM, Mazumdar M (2011) Is there a role for expectation maximization imputation in addressing missing data in research using WOMAC questionnaire? Comparison to the standard mean approach and a tutorial. BMC Musculoskelet Disord 12:109PubMedCrossRefPubMedCentral
19.
Gupta S, Augustine A, Horey L, Meek RM, Hullin MG, Mohammed A (2010) Electrocautery of the patellar rim in primary total knee replacement: beneficial or unnecessary? J Bone Joint Surg Br 92:1259–1261PubMedCrossRef
20.
He JY, Jiang LS, Dai LY (2011) Is patellar resurfacing superior than nonresurfacing in total knee arthroplasty? A meta-analysis of randomized trials. Knee 18:137–144PubMedCrossRef
21.
Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558PubMedCrossRef
22.
Hirasawa Y, Okajima S, Ohta M, Tokioka T (2000) Nerve distribution to the human knee joint: anatomical and immunohistochemical study. Int Orthop 24:1–4PubMedCrossRefPubMedCentral
23.
Judge A, Arden NK, Kiran A, Price A, Javaid MK, Beard D (2012) Interpretation of patient-reported outcomes for hip and knee replacement surgery: identification of thresholds associated with satisfaction with surgery. J Bone Joint Surg Br 94:412–418PubMedCrossRef
24.
25.
Keblish PA, Greenwald SA (1990) comparison of patella retention and patella replacement in LCS mobile bearing TKA: a prospetive comparison of 52 knees in 26 patients. Orthop Trans 14:599
26.
Keblish PA, Varma AK, Greenwald AS (1994) Patellar resurfacing or retention in total knee arthroplasty. A prospective study of patients with bilateral replacements. J Bone Joint Surg Br 76:930–937PubMed
27.
Khanna G, Singh JA, Pomeroy DL, Gioe TJ (2011) Comparison of patient-reported and clinician-assessed outcomes following total knee arthroplasty. J Bone Joint Surg Am. 93:e117(1)–e117(7)
28.
Kim TH, Lee DH, Bin SI (2008) The NexGen LPS-flex to the knee prosthesis at a minimum of three years. J Bone Joint Surg Br 90:1304–1310PubMedCrossRef
29.
Kong CG, Cho HM, Suhl KH, Kim MU, In Y (2012) Patellar tracking after total knee arthroplasty performed without lateral release. Knee 19:692–695PubMedCrossRef
30.
Lehner B, Koeck FX, Capellino S, Schubert TE, Hofbauer R, Straub RH (2008) Preponderance of sensory versus sympathetic nerve fibers and increased cellularity in the infrapatellar fat pad in anterior knee pain patients after primary arthroplasty. J Orthop Res 26:342–350PubMedCrossRef
31.
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 19:198–202PubMedCrossRef
32.
Maralcan G, Kuru I, Issi S, Esmer AF, Tekdemir I, Evcik D (2005) The innervation of patella: anatomical and clinical study. Surg Radiol Anat 27:331–335PubMedCrossRef
33.
Parvizi J, Rapuri VR, Saleh KJ, Kuskowski MA, Sharkey PF, Mont MA (2005) Failure to resurface the patella during total knee arthroplasty may result in more knee pain and secondary surgery. Clin Orthop Relat Res 438:191–196PubMedCrossRef
34.
Pavlou G, Meyer C, Leonidou A, As-Sultany M, West R, Tsiridis E (2011) Patellar resurfacing in total knee arthroplasty: does design matter? A meta-analysis of 7075 cases. J Bone Joint Surg Am 93:1301–1309PubMedCrossRef
35.
Pierson JL, Ritter MA, Keating EM, Faris PM, Meding JB, Berend ME (2007) The effect of stuffing the patellofemoral compartment on the outcome of total knee arthroplasty. J Bone Joint Surg Am 89:2195–2203PubMedCrossRef
36.
Popovic N, Lemaire R (2003) Anterior knee pain with a posterior-stabilized mobile-bearing knee prosthesis: the effect of femoral component design. J Arthroplasty 18:396–400PubMedCrossRef
37.
Rand JA, Gaffey TA (1985) Effect of electrocautery on fresh human articular cartilage. Arthroscopy 1:242–246PubMedCrossRef
38.
Rodríguez-Merchán EC, Gómez-Cardero P (2010) The outerbridge classification predicts the need for patellar resurfacing in TKA. Clin Orthop Relat Res 468:1254–1257PubMedCrossRefPubMedCentral
39.
Saoud AMF (2004) Patellar denervation in non-patellar resurfacing total knee arthroplasty. Pan Arab J Orth Trauma 8:25–30
40.
Schindler OS (2012) The controversy of patellar resurfacing in total knee arthroplasty: Ibisne in medio tutissimus? Knee Surg Sports Traumatol Arthrosc 20: 1227–1244
41.
Shih HN, Shih LY, Wong YC (2004) Hsu RW (2004) Long-term changes of the nonresurfaced patella after total knee arthroplasty. J Bone Joint Surg Am 86:935–939PubMedCrossRef
42.
Smith AJ, Lloyd DG, Wood DJ (2004) Pre-surgery knee joint loading patterns during walking predict the presence and severity of anterior knee pain after total knee arthroplasty. J Orthop Res 22:260–266PubMedCrossRef
43.
Stärke C, Röpke EF, Lohmann CH (2011) The third compartment in knee endoprosthetics: from denervation to replacement, which therapy is correct? Orthopade 40(896–8):900–901
44.
Stein DT, Ricciardi CA, Viehe T (2002) The effectiveness of the use of electrocautery with chondroplasty in treating chondromalacic lesions: a randomized prospective study. Arthroscopy 18:190–193PubMedCrossRef
45.
Sun YQ, Yang B, Tong SL, Sun J, Zhu YC (2012) Patelloplasty versus traditional total knee arthroplasty for osteoarthritis. Orthopedics 35:e343–e348PubMed
46.
van Hemert WL, Senden R, Grimm B, Kester AD, van der Linde MJ, Heyligers IC (2009) Patella retention versus replacement in total knee arthroplasty; functional and clinimetric aspects. Arch Orthop Trauma Surg 129:259–265PubMedCrossRef
47.
van Jonbergen HP, Barnaart AF, Verheyen CC (2010) A dutch survey on circumpatellar electrocautery in total knee arthroplasty. Open Orthop J 4:201–203PubMedCrossRefPubMedCentral
48.
van Jonbergen HP, Reuver JM, Mutsaerts EL, Poolman RW (2012) Determinants of anterior knee pain following total knee replacement: a systematic review. Knee Surg Sports Traumatol Arthrosc. doi: 10.​1007/​s00167-012-2294-x
49.
van Jonbergen HP, Scholtes VA, van Kampen A, Poolman RW (2011) A randomised, controlled trial of circumpatellar electrocautery in total knee replacement without patellar resurfacing. J Bone Joint Surg Br 93:1054–1059PubMedCrossRef
50.
Vega J, Golanó P, Pérez-Carro L (2006) Electrosurgical arthroscopic patellar denervation. Arthroscopy 22:1028 e1–e3
51.
Whiteside LA, Nakamura T (2003) Effect of femoral component design on unresurfaced patellas in knee arthroplasty. Clin Orthop Relat Res 410:189–198PubMedCrossRef
52.
Wojtys EM, Beaman DN, Glover RA, Janda D (1990) Innervation of the human knee joint by substance-P fibers. Arthroscopy 6:254–263PubMedCrossRef
53.
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 84:187–193PubMed
54.
Yim SJ, Jang MS, Kim WJ, Lee SH, Kang HK (2012) The effect of electrocautery around the patellar rim in patellar non-resurfacing total knee arthroplasty. Knee Surg Relat Res 24:104–107PubMedCrossRefPubMedCentral
Metadata
Title
Patellar denervation with electrocautery in total knee arthroplasty without patellar resurfacing: a meta-analysis
Authors
Tao Cheng
Chen Zhu
Yongyuan Guo
Sifeng Shi
Desheng Chen
Xianlong Zhang
Publication date
01-11-2014
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-013-2533-9

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