Motififard Mehdi, Nazem Khalilollah, Zarfeshani Aida, Zarfeshani Kaveh
Department of Orthopedic Surgery, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Developmental Epigenetics Group, Liggins Institute, The University of Auckland, Grafton, Auckland 1023, New Zealand.
Adv Biomed Res. 2018 Jan 30;7:9. doi: 10.4103/abr.abr_154_16. eCollection 2018.
Anterior knee pain is a major problem in total knee arthroplasty (TKA). It is accepted that anterior knee pain (AKP) often contributes to a patellofemoral etiology; however, its etiology or treatment is not understood completely. Disabling pain receptors by electrocautery could theoretically lead to anterior knee area denervation. The present study aimed to evaluate the pain post-patellar denervation (PD) with electrocautery in TKA.
Clinical results for 92 patients who underwent TKA (58 women, 34 men; mean age 67.5 years) were analyzed. In addition to removal of all osteophytes, PD by electrocautery was performed on patella of treatment group ( = 46) and debridement alone including removing of all osteophytes was performed on the control group ( = 46). Knee Society System (KSS) score, patella score (PS), and visual analog scale (VAS) were used to determine pre- and post-operative AKP.
The follow-up duration was 10 months. No revision or reoperations were performed. There were no patellar fractures. On all parameters (KSS score, PS, and VAS), there was a statistically significant pre- to post-operative difference in favor of the denervation group only 3 weeks after operation; however, there was no statistically difference postoperation on other follow-ups (3, 6, and 10 months).
PD with electrocautery could reduce AKP in TKA without patellar resurfacing only in a short-term period postoperation.
膝关节前侧疼痛是全膝关节置换术（TKA）中的一个主要问题。人们普遍认为，膝关节前侧疼痛（AKP）通常源于髌股关节病因；然而，其病因或治疗方法尚未完全明确。理论上，通过电灼使疼痛感受器失活可能导致膝关节前侧区域去神经支配。本研究旨在评估TKA中采用电灼进行髌骨去神经支配（PD）后的疼痛情况。
分析了92例行TKA患者（58例女性，34例男性；平均年龄67.5岁）的临床结果。除切除所有骨赘外，治疗组（n = 46）对髌骨进行电灼PD，对照组（n = 46）仅进行包括切除所有骨赘在内的清创术。采用膝关节协会系统（KSS）评分、髌骨评分（PS）和视觉模拟量表（VAS）来确定术前和术后的AKP。
随访时间为10个月。未进行翻修或再次手术。未发生髌骨骨折。在所有参数（KSS评分、PS和VAS）方面，仅在术后3周时，去神经支配组术前至术后有统计学显著差异；然而，在其他随访时间点（3、6和10个月）术后无统计学差异。
电灼PD仅在术后短期内可减轻TKA中的AKP，且无需髌骨表面置换。
