Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand.
J Arthroplasty. 2021 Apr;36(4):1295-1301. doi: 10.1016/j.arth.2020.10.046. Epub 2020 Oct 27.
The benefit of patellar denervation (PD) in patellar resurfacing total knee arthroplasty (TKA) is still debatable. This prospective, randomized controlled trial investigated whether circumferential PD should be performed in patellar resurfacing TKA.
A total of 241 patients who underwent unilateral TKA were randomized into PD or non-PD groups. Incidence, intensity, and presentation time of anterior knee pain (AKP) and clinical outcomes were evaluated at 3, 6, 9, 12, 18, and 24 months postoperatively.
The incidence of AKP was significantly lower in the PD group (6.4% vs 16.2%, P = .032). The intensity of AKP and patient satisfaction scores were significantly better in the PD group at 3 months but not after 3 months. The presentation time of AKP mostly occurs at 3 months after surgery. The Knee Society score, range of motion, Oxford score, patellar score, activity of daily living score, and visual analog scale of overall knee pain were not significantly different between the two groups during the follow-up period.
Given that PD can improve AKP and patient satisfaction at an early period postoperatively without jeopardizing clinical outcomes at no additional cost, this inexpensive procedure readily available in nearly every operation room is strongly recommended during primary TKA with patellar resurfacing.
髌骨去神经支配（PD）在髌骨表面置换全膝关节置换术（TKA）中的益处仍存在争议。本前瞻性、随机对照试验研究了髌骨表面置换 TKA 中是否应行环形 PD。
241 例单侧 TKA 患者随机分为 PD 或非 PD 组。术后 3、6、9、12、18 和 24 个月评估膝关节前痛（AKP）的发生率、强度和出现时间以及临床结果。
PD 组 AKP 的发生率明显较低（6.4%比 16.2%，P =.032）。PD 组在 3 个月时 AKP 强度和患者满意度评分明显更好，但在 3 个月后则不然。AKP 的出现时间大多在术后 3 个月。在随访期间，两组之间的膝关节学会评分、关节活动度、牛津评分、髌骨评分、日常生活活动评分和全膝关节疼痛视觉模拟评分均无显著差异。
鉴于 PD 可在术后早期改善 AKP 和患者满意度，而不会对临床结果造成损害，且不会增加额外费用，因此，对于髌骨表面置换的初次 TKA，强烈推荐在几乎每个手术室都能轻松实施的这种廉价手术。
