Patellar denervation is not useful in total knee arthroplasty with patellar resurfacing
ESSKA Academy. Hinarejos P. Nov 8, 2019; 284390; epEKA-59 Topic: Joint Replacement
Pedro Hinarejos
Pedro Hinarejos
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Patellar denervation is not useful in total knee arthroplasty with patellar resurfacing

ePoster - epEKA-59

Topic: TKA

Hinarejos P., Goicoechea N., Leal-Blanquet J., Torres-Claramunt R., Sanchez-Soler J., Monllau J.C.
Parc de Salut Mar, Barcelona, Spain

Introduction: Anterior knee pain (AKP) after total knee arthroplasty (TKA) is frequent. Different studies have evaluated the effect of patellar denervation after a TKA without prosthetic patella, with better clinical results in the short-term follow-up, but there is a lack of studies of patellar denervation when the patellar component is replaced.
Aim: To evaluate the efect of patellar denervation to reduce AKP in patients with a TKA with replacement of the patella.
Material and methods: A prospective randomized study was designed, and 202 unilateral TKA with patellar component were included. In group 1 a patellar denervation was performed and in group 2 it was not done.
Patients with subsequent surgeries, or missed in the postoperative follow-up were excluded.
The average age of the patients was 72.7 years. Gender was 70.2% women and 29.8% men. The mean body mass index was 31.4. These data were similar in both groups.
Pain and patellar function were evaluated according to Feller´s patellofemoral score, and the knee and functional status was evaluated by KSS. The VAS scores reported at rest, walking and descending stairs were recorded.The pressure pain threshold (PPT) was quantified by pressure algometry (PA) applied 3 times in over the patella with an electronic algometer. PPT was considered the average of the 3 measurements. All the variables were collected in the preoperative and at 12 postoperative months.
A regular statistical analysis was done and p-value less than 0.05 were considered significant.
Results: The mean preoperative (12.6 vs 13.6; p=ns) and postoperative (24.4 and 25.9; p=ns) Feller score values were similar in both groups.The mean preoperative (52.7 vs 51.6) and postoperative (91.53 vs 92.91) KSS were similar in both groups.The mean preoperative VAS values were similar in both groups. The mean postoperative VAS values were 0.78 and 0.41 at rest (p = n.s); 1.58 and 0.85 when walking; and 2.93 and 1.59 descending stairs (p = 0.02), in groups 1 and 2. Preoperative pressure algometry values were similar in both groups. The mean PPT postoperative values were 494.4 KPa in the denervation group and 552.4 KPa in group 2 (p = 0.047).
Conclusions: Patellar denervation in this study, in which we have prosthetized the patella in all the knees, does not provide any improvement in the knee scores with respect to the TKA without denervation. We do not recommend using patellar denervation with electrocautery if patella is replaced in a TKA.
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