University of Health Sciences, Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık mah., Kazım Karabekir cd, Muratpasa, Antalya, 07100, Turkey.
J Orthop Surg Res. 2024 Oct 15;19(1):653. doi: 10.1186/s13018-024-05161-5.
This study aimed to evaluate the effectiveness of circumferential patellar denervation in reducing anterior knee pain (AKP) and improving clinical outcomes after total knee arthroplasty (TKA) without patellar resurfacing.
This prospective, non-randomized, observational study included patients who underwent primary TKA at our institution between August 2023 and January 2024. Patients were divided into two groups: those who received patellar denervation (PD group) and those who did not (NPD group). The primary outcome was the reduction in anterior knee pain (AKP), measured by the Visual Analog Scale (VAS). Secondary outcomes included the Kujala Knee Score, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and range of motion (ROM). Assessments were conducted preoperatively and at 3 and 6 months postoperatively.
Four patients in the PD group and five in the NPD group were excluded from the study due to failure to complete follow-up. Thus, 74 female and 16 male patients with a mean age of 67.4 ± 4.2 years were included in the final analysis. There were no significant differences between the two groups with respect to age, sex, side of surgery, height, weight, BMI, grade of patellofemoral osteoarthritis, preoperative ROM, VAS score, Kujala score, and WOMAC score (p: n.s. for all variables). No significant differences were found between the groups for VAS, Kujala, and WOMAC scores at any time point (p: n.s.). Significant improvements in these scores over time were indicated by repeated measures ANOVA (p = 0.001 for both groups). Pairwise comparisons showed significant improvements from preoperative to postoperative months three and six and from postoperative months three to six (p = 0.001 for all comparisons). Both groups experienced decreased knee ROM at third month, which returned to preoperative values at sixth month with no significant differences. No complications were observed during the study.
Circumferential patellar denervation does not provide additional benefit in reducing anterior knee pain or improving functional outcomes compared to the non-denervation approach in TKA without patellar resurfacing.
Level III, Prospective comparative study.
本研究旨在评估环形髌骨去神经术在不进行髌骨表面置换的全膝关节置换（TKA）后减少前膝痛（AKP）和改善临床结果的有效性。
这是一项前瞻性、非随机、观察性研究，纳入了 2023 年 8 月至 2024 年 1 月期间在我院接受初次 TKA 的患者。患者分为两组：接受髌骨去神经术（PD 组）和未接受髌骨去神经术（NPD 组）。主要结局是通过视觉模拟评分（VAS）测量的前膝痛（AKP）的减少。次要结局包括 Kujala 膝关节评分、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和活动范围（ROM）。评估在术前和术后 3 个月和 6 个月进行。
PD 组有 4 例和 NPD 组有 5 例患者因未能完成随访而被排除在研究之外。因此，最终分析纳入了 74 名女性和 16 名男性患者，平均年龄 67.4±4.2 岁。两组在年龄、性别、手术侧、身高、体重、BMI、髌股关节炎分级、术前 ROM、VAS 评分、Kujala 评分和 WOMAC 评分方面无显著差异（p：所有变量均为 n.s.）。两组在任何时间点的 VAS、Kujala 和 WOMAC 评分均无显著差异（p：n.s.）。重复测量方差分析表明这些评分随时间的显著改善（两组 p=0.001）。两两比较显示，术后 3 个月和 6 个月以及术后 3 个月和 6 个月之间的评分均有显著改善（所有比较 p=0.001）。两组在术后 3 个月时膝关节 ROM 均减少，但在术后 6 个月时恢复到术前水平，无显著差异。研究期间未观察到并发症。
与不进行髌骨表面置换的 TKA 相比，环形髌骨去神经术在不进行髌骨表面置换的 TKA 中不能提供额外的益处，不能减轻前膝痛或改善功能结局。
III 级，前瞻性比较研究。
