Feng Hui, Feng Ming-Li, Cheng Jing-Bo, Zhang Xiang, Tao Hai-Cheng
Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
World J Orthop. 2024 Feb 18;15(2):180-191. doi: 10.5312/wjo.v15.i2.180.
Total knee arthroplasty (TKA) is a mature procedure recommended for correcting knee osteoarthritis deformity, relieving pain, and restoring normal biomechanics. Although TKA is a successful and cost-effective procedure, patient dissatisfaction is as high as 50%. Knee pain after TKA is a significant cause of patient dissatisfaction; the most common location for residual pain is the anterior region. Between 4% and 40% of patients have anterior knee pain (AKP).
To investigate the effect of various TKA procedures on postoperative AKP.
We searched PubMed, EMBASE, and Cochrane from January 2000 to September 2022. Randomized controlled trials with one intervention in the experimental group and no corresponding intervention (or other interventions) in the control group were collected. Two researchers independently read the title and abstract of the studies, preliminarily screened the articles, and read the full text in detail according to the selection criteria. Conflicts were resolved by consultation with a third researcher. And relevant data from the included studies were extracted and analyzed using Review Manager 5.4 software.
There were 25 randomized controlled trials; 13 were comparative studies with or without patellar resurfacing. The meta-analysis showed no significant difference between the experimental and control groups ( = 0.61). Six studies were comparative studies of circumpatellar denervation non-denervation, divided into three subgroups for meta-analysis. The two-subgroup meta-analysis showed no significant difference between the experimental and the control groups ( = 0.31, = 0.50). One subgroup meta-analysis showed a significant difference between the experimental and control groups ( = 0.001). Two studies compared fixed-bearing TKA and mobile-bearing TKA; the results meta-analysis showed no significant difference between the experimental and control groups ( = 0.630). Two studies compared lateral retinacular release non-release; the meta-analysis showed a significant difference between the experimental and control groups ( = 0.002); two other studies compared other factors.
Patellar resurfacing, mobile-bearing TKA, and fixed-bearing TKA do not reduce the incidence of AKP. Lateral retinacular release can reduce AKP; however, whether circumpatellar denervation can reduce AKP is controversial.
全膝关节置换术（TKA）是一种成熟的手术，推荐用于矫正膝关节骨关节炎畸形、缓解疼痛和恢复正常生物力学。尽管TKA是一种成功且具有成本效益的手术，但患者不满意率高达50%。TKA术后膝关节疼痛是患者不满意的一个重要原因；残留疼痛最常见的部位是前部区域。4%至40%的患者有膝前疼痛（AKP）。
探讨各种TKA手术对术后AKP的影响。
我们检索了2000年1月至2022年9月的PubMed、EMBASE和Cochrane数据库。收集实验组有一项干预措施而对照组无相应干预措施（或其他干预措施）的随机对照试验。两名研究人员独立阅读研究的标题和摘要，初步筛选文章，并根据选择标准详细阅读全文。通过与第三位研究人员协商解决分歧。使用Review Manager 5.4软件提取并分析纳入研究的相关数据。
有25项随机对照试验；13项是有或没有髌骨表面置换的比较研究。荟萃分析显示实验组和对照组之间无显著差异（ = 0.61）。六项研究是髌周去神经支配与非去神经支配的比较研究，分为三个亚组进行荟萃分析。两亚组荟萃分析显示实验组和对照组之间无显著差异（ = 0.31， = 0.50）。一项亚组荟萃分析显示实验组和对照组之间有显著差异（ = 0.001）。两项研究比较了固定平台TKA和活动平台TKA；结果荟萃分析显示实验组和对照组之间无显著差异（ = 0.630）。两项研究比较了外侧支持带松解与未松解；荟萃分析显示实验组和对照组之间有显著差异（ = 0.002）；另外两项研究比较了其他因素。
髌骨表面置换、活动平台TKA和固定平台TKA并不能降低AKP的发生率。外侧支持带松解可降低AKP；然而，髌周去神经支配是否能降低AKP存在争议。
