Department of Orthopaedics and Traumatology, Harran University School of Medicine, Yenisehir, 63100 Sanliurfa, Turkey.
Orthop Traumatol Surg Res. 2012 Jun;98(4):421-5. doi: 10.1016/j.otsr.2012.03.002. Epub 2012 May 1.
Anterior knee pain is still a major problem in total knee arthroplasty (TKA). Although the most widely accepted opinion is that anterior knee pain is often associated with a patellofemoral etiology, there is no clear consensus as to etiology or treatment. Disabling pain receptors by electrocautery could theoretically achieve denervation of the anterior knee region. The present prospective randomized controlled study aimed to evaluate results after patellar denervation with electrocautery in TKA at a minimum follow-up of 2 years.
Patellar denervation provides some benefit in terms of pain and clinical outcomes after TKA without patellar resurfacing.
Clinical and radiological results for 35 patients with single-stage bilateral TKA (70 knees; 26 women, nine men; mean age, 68 years [range, 58 to 77 years]) were reviewed. In addition to removal of all osteophytes, patellar denervation by electrocautery was performed on one patella; and debridement alone, removing all osteophytes, was performed on the contralateral patella, as a control. KSS score and a visual analog scale (VAS) were used to assess pre- and postoperative anterior knee pain.
Mean follow-up was 36 months (24 to 60 months). No revisions or re-operations were performed. There were no patellar fractures. On all parameters (KSS score, range of motion and VAS), there was a statistically significant pre- to postoperative difference in favor of the denervation group.
Patellar denervation with electrocautery can reduce anterior knee pain, with satisfactory clinical and radiological outcome, in TKA without patellar resurfacing.
Level II: low-powered prospective randomized trial.
膝关节置换术后（TKA）前膝痛仍是一个主要问题。尽管最广泛接受的观点是前膝痛常与髌股病因有关，但对于病因或治疗方法尚无明确共识。电灼术可使疼痛感受器失活，理论上可实现前膝区去神经支配。本前瞻性随机对照研究旨在评估 TKA 中髌旁去神经支配（电灼术）至少 2 年的随访结果。
髌旁去神经支配可减轻 TKA 后无髌骨再表面化的前膝疼痛，并改善临床结局。
回顾了 35 例接受单阶段双侧 TKA（70 膝；26 例女性，9 例男性；平均年龄 68 岁[58 至 77 岁]）的患者的临床和影像学结果。除了切除所有骨赘外，还对一侧髌骨进行电灼去神经支配；而对另一侧髌骨仅进行单纯清创术，切除所有骨赘作为对照。采用 KSS 评分和视觉模拟评分（VAS）评估术前和术后前膝疼痛。
平均随访 36 个月（24 至 60 个月）。无翻修或再手术。无髌骨骨折。在所有参数（KSS 评分、活动范围和 VAS）上，去神经支配组在术前至术后均有统计学显著差异。
在 TKA 中不进行髌骨再表面化的情况下，电灼术可减少前膝疼痛，且具有满意的临床和影像学结果。
II 级：低效能前瞻性随机试验。
