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
Level 1 Randomized Control Trial
Materials and Methods
- 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 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).
- 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.
- 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