Deekshith S R K, Reddy K J, Raviteja R
Department of Orthopedics, SVS Medical College and Hospital, Mahabubnagar, Telangana State, 500062, India.
Arthroplasty. 2020 Sep 11;2(1):26. doi: 10.1186/s42836-020-00044-6.
Anterior knee pain is one of the major problems in total knee arthroplasty (TKA) and is often etiologically associated with a patellofemoral parts etiology. There is no consensus as to etiology or treatment. Denervation of the patella by electrocautery and patelloplasty along with removal of osteophytes have been used for treatment of anterior knee pain in TKA. The purpose of our study was to compare, in terms of the anterior knee pain and clinical outcomes of patelloplasty in total knee arthroplasty (TKA), patellar denervation by electrocautery and non-patellar-denervation treatment in a 2 year follow-up.
This study was conducted in a total of 108 patients, who underwent TKA at our institution between June 2015 and December 2016. Patients age 55 to 80 years, who are suffering from osteoarthritis, rheumatoid arthritis of knee were included in this study. Patients were randomly allocated into patelloplasty with denervation group and non-denervation group. The denervation of the patella was done in electrocautery group using a monopolar coagulation diathermy set to 50 W. (Valleylab Inc., Boulder, CO). Postoperatively, patients were assessed at regular intervals of 3, 6, 9, 12, 24 months. To assess patient outcomes, we used questionnaires to determine the Knee Society score (KSS - knee and function scores), a specific patellofemoral pain questionnaire (Kujala score) range of motion (ROM) and a visual analogue scale (VAS) to assess anterior knee pain.
The data obtained were analyzed using SPSS version 17.0. Continuous variables were expressed as mean ± SD. Of the 108 patients, 9 patients were lost to follow-up. Among the remaining 99 patients, 50 were included in denervation group and 49 in non-denervation group. In our study, there was no statistically significant difference in Mean KUJALA score preoperatively (p > 0.05). Postoperatively, the mean KUJALA score was significantly higher in denervation group at 3, 6, 9, 12, 24 months of follow-up when compared to TKR with no denervation (p < 0.05). There was no statistically significant difference in Mean VAS score preoperatively (p > 0.05). However, 6, 12 and 24 months after the operation, the mean VAS score was significantly lower in denervation group. There was no statistically significant difference in Mean KSS score preoperatively and postoperatively (p > 0.05). The mean ROM was significantly higher in denervation group than in the group of TKR with no denervation (p < 0.05).
In our study, less postoperative anterior knee pain, increased range of motion, significantly lower VAS scores were seen in the denervation group compared with non-denervation group. Circumferential denervation of patella during primary TKA along with patellar resurfacing is a safe procedure that improves patient satisfaction, decreases anterior knee pain and improves range of flexion in the postoperative period and at postoperative follow-ups.
膝关节前侧疼痛是全膝关节置换术（TKA）中的主要问题之一，其病因通常与髌股关节部分病因相关。关于病因和治疗尚无共识。通过电灼法进行髌骨去神经支配以及髌骨成形术并去除骨赘已被用于治疗TKA中的膝关节前侧疼痛。我们研究的目的是在全膝关节置换术（TKA）中，就膝关节前侧疼痛和髌骨成形术的临床结果，比较电灼法髌骨去神经支配与非髌骨去神经支配治疗在2年随访中的情况。
本研究共纳入108例于2015年6月至2016年12月在我院接受TKA的患者。纳入年龄在55至80岁、患有膝关节骨关节炎、类风湿性关节炎的患者。患者被随机分为去神经支配的髌骨成形术组和非去神经支配组。在电灼法组中，使用设置为50W的单极电凝透热设备（Valleylab公司，科罗拉多州博尔德市）对髌骨进行去神经支配。术后，定期在3、6、9、12、24个月对患者进行评估。为评估患者的结果，我们使用问卷来确定膝关节协会评分（KSS - 膝关节和功能评分）、特定的髌股关节疼痛问卷（库贾拉评分）、活动范围（ROM）以及视觉模拟量表（VAS）来评估膝关节前侧疼痛。
使用SPSS 17.0版本对获得的数据进行分析。连续变量表示为均值±标准差。108例患者中，9例失访。在其余99例患者中，50例纳入去神经支配组，49例纳入非去神经支配组。在我们的研究中，术前平均库贾拉评分无统计学显著差异（p＞0.05）。术后，与未进行去神经支配的TKR相比，去神经支配组在随访的3、6、9、12、24个月时平均库贾拉评分显著更高（p＜0.05）。术前平均VAS评分无统计学显著差异（p＞0.05）。然而，术后6、12和24个月，去神经支配组的平均VAS评分显著更低。术前和术后平均KSS评分无统计学显著差异（p＞0.05）。去神经支配组的平均ROM显著高于未进行去神经支配的TKR组（p＜0.05）。
在我们的研究中，与非去神经支配组相比，去神经支配组术后膝关节前侧疼痛更少、活动范围增加、VAS评分显著更低。在初次TKA期间对髌骨进行环周去神经支配并同时进行髌骨表面置换是一种安全的手术方法，可提高患者满意度、减轻膝关节前侧疼痛并改善术后及随访期的屈曲范围。
