Patella Denervation improves patient satisfaction following TKA

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Patella Denervation in Primary Total Knee Arthroplasty – A Randomized Controlled Trial with 2 Years of Follow-Up

Ramnadh S. Pulavarti, Videsh V. Raut, George J. McLauchlan

Department of Orthopaedics and Trauma, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley and South Ribble Hospital, Chorley, Lancashire, United Kingdom

DOI: http://dx.doi.org/10.1016/j.arth.2013.10.017

The Journal of Arthroplasty Volume 29, Issue 5, Pages 977–981, May 2014joa

Level 1 Randomized Control Trial

Materials and Methods

POPULATION-

  • 126 patients scheduled to undergo primary TKA due to osteoarthritis were included in the study.
  • Surgery was standardized in all patients- a midline incision and medial parapatellar approach was used , and cruciate retaining implants were used.
  • Postoperative physiotherapy protocol was similar in all groups

INTERVENTION- Denervation Group: 63 patients

  • This group of patients underwent a standard TKA procedure and received denervation of the patella using monopolar coagulation diathermy (valleylab inc.,Boulder,CO) set 50 W.
  • DVT Prophylaxis included- LMW heparin injection, which was continued until patients were fully mobile and discharged from care (Mean age:69.9, 31M/32F)

COMPARISON- Control group: 63 patients

  • Patient in this group underwent a standard TKA procedure with no denervation of the patella (Mean age:69.8)
  • 58 patients completed follow up, there were 27M/36F

OUTCOMES-

  • Outcomes measurements used: Patient satisfaction, Oxford Knee Score(OKS), Knee Society score(KSS) and Knee Society Function score, patellar score, activities of Daily Living(ADL), VAS for anterior knee pain , and UCLA score

METHODS-RCT: single center, Double Blind

Duration: 24 months(Follow –up scheduled for 2, 12, and 24 months postoperatively).

Results:

  • Pain scores for anterior knee pain, patella scores were significantly better in the denervation group at 3 months but not at 12 and 24 months.
  • Patient satisfaction was higher in the denervation group.
  • Flexion range was higher in the denervation group at 3, 12 and 24 months review (P<0.01).
  • There were, however, no statistically significant differences with other validated knee scores.

Conclusion:

  • Patellar denervation is a simple procedure in TKA with improved patient satisfaction, although it is not associated with significant improvement in validated knee outcomes.  It is not associated with any significant complications

Ref:

1.http://www.arthroplastyjournal.org/article/S0883-5403(13)00799-7/fulltext

2 www.myorthoevidence.com

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