van Jonbergen H P W, Scholtes V A B, van Kampen A, Poolman R W
Department of Orthopaedic Surgery, Deventer Hospital, P. O. Box 5001, 7400 GC Deventer, The Netherlands.
J Bone Joint Surg Br. 2011 Aug;93(8):1054-9. doi: 10.1302/0301-620X.93B8.26560.
The efficacy of circumpatellar electrocautery in reducing the incidence of post-operative anterior knee pain is unknown. We conducted a single-centre, outcome-assessor and patient-blinded, parallel-group, randomised, controlled trial to compare circumpatellar electrocautery with no electrocautery in total knee replacement in the absence of patellar resurfacing. Patients requiring knee replacement for primary osteoarthritis were randomly assigned circumpatellar electrocautery (intervention group) or no electrocautery (control group). The primary outcome measure was the incidence of anterior knee pain. A secondary measure was the standardised clinical and patient-reported outcomes determined by the American Knee Society scores and the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. A total of 131 knees received circumpatellar electrocautery and 131 had no electrocautery. The overall incidence of anterior knee pain at follow-up at one year was 26% (20% to 31%), with 19% (12% to 26%) in the intervention group and 32% (24% to 40%) in the control group (p = 0.02). The relative risk reduction from electrocautery was 40% (9% to 61%) and the number needed to treat was 7.7 (4.3 to 41.4). The intervention group had a better mean total WOMAC score at follow-up at one year compared with the control group (16.3 (0 to 77.7) versus 21.6 (0 to 76.7), p = 0.04). The mean post-operative American Knee Society knee scores and function scores were similar in the intervention and control groups (knee score: 92.4 (55 to 100) versus 90.4 (51 to 100), respectively (p = 0.14); function score: 86.5 (15 to 100) versus 84.5 (30 to 100), respectively (p = 0.49)). Our study suggests that in the absence of patellar resurfacing electrocautery around the margin of the patella improves the outcome of total knee replacement.
髌周电灼术在降低术后前膝痛发生率方面的疗效尚不清楚。我们进行了一项单中心、结局评估者和患者双盲、平行组、随机对照试验，以比较在未进行髌骨表面置换的全膝关节置换术中髌周电灼术与非电灼术的效果。因原发性骨关节炎需要进行膝关节置换的患者被随机分配接受髌周电灼术（干预组）或非电灼术（对照组）。主要结局指标是前膝痛的发生率。次要指标是由美国膝关节协会评分和西安大略和麦克马斯特大学（WOMAC）骨关节炎指数确定的标准化临床和患者报告结局。共有131个膝关节接受了髌周电灼术，131个未接受电灼术。随访一年时前膝痛的总体发生率为26%（20%至31%），干预组为19%（12%至26%），对照组为32%（24%至40%）（p = 0.02）。电灼术使相对风险降低了40%（9%至61%），所需治疗人数为7.7（4.3至41.4）。与对照组相比，干预组在随访一年时的平均WOMAC总分更好（16.3（0至77.7）对21.6（0至76.7），p = 0.04）。干预组和对照组术后的美国膝关节协会膝关节评分和功能评分均值相似（膝关节评分：分别为92.4（55至100）和90.4（51至100）（p = 0.14）；功能评分：分别为86.5（15至100）和84.5（30至100）（p = 0.49））。我们的研究表明，在未进行髌骨表面置换的情况下，髌骨边缘周围的电灼术可改善全膝关节置换的效果。
