Association Between Femoral Component Sagittal Positioning and Anterior Knee Pain in Total Knee Arthroplasty

Scott, Chloe E H; Clement, Nicholas D.; Yapp, Liam Z; MacDonald, Deborah J.; Patton, James T.; Burnett, Richard T.

doi:10.2106/jbjs.18.01096

Cited by 46 publications

(34 citation statements)

References 27 publications

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“…As patellar resurfacing could result in several complications, such as fracture, loosening, and dislocation 19,20 , many surgeons prefer to not perform patellar resurfacing in TKA. Though not clearly understood, there are many reasons for the AKP, such as infrapatellar fat pad excision, the design and position of the implant, the size and rotation of the trochlear groove, and the surgical technique 21,22 . Theoretically, blocking superficial sensory nerves around the patella could reduce the incidence of AKP and improve the knee function after TKA.…”

Section: Discussionmentioning

confidence: 99%

Effect of Patellar Denervation on Anterior Knee Pain and Knee Function in Total Knee Arthroplasty without Patellar Resurfacing: A Meta‐Analysis of Randomized Controlled Trials

Wang

Feng

Zang

et al. 2020

Orthopaedic Surgery

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The aim of the present study was to evaluate the effect of patellar denervation (PD) in preventing anterior knee pain (AKP) and improving knee function after total knee arthroplasty (TKA) without patellar resurfacing, and to help surgeons decide whether or not to use PD in TKA. Methods: The electronic databases of Pubmed, Embase, Cochrane, Web of Science, and Scopus were searched for all randomized controlled trials (RCT) comparing the outcomes of PD and no patellar denervation (NPD) in TKA without patellar resurfacing. Primary outcomes were incidence of AKP, visual analogue scale for pain (VAS), and patellar score (PS). Secondary outcomes were Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Knee Score (OKS), knee range of motion (ROM), and complications. Results: A total of nine RCT met the inclusion criteria. On meta-analysis, PD significantly reduced the incidence of AKP (odds ratio 0.49; 95% confidence interval [CI] 0.26 to 0.92), reduced the VAS (weighted mean difference [WMD] −0.57; 95% CI −1.02 to −0.11), and improved the WOMAC (WMD −4.63; 95% CI −6.49 to −2.77) and the ROM (WMD 9.60; 95% CI 0.39 to 18.81) during the follow-up within 12 months. In addition, PD improved the PS (WMD 1.01; 95% CI 0.65 to 1.38), KSS (WMD 1.12; 95% CI 0.10 to 2.14), and the WOMAC (WMD −1.41; 95% CI −2.74 to −0.08) during the follow-up after 12 months. Conclusion: Patellar denervation could significantly reduce the VAS and the incidence of AKP in the early stages after TKA as well as improve the clinical outcomes in terms of the PS, the WOMAC, the KSS, and the ROM. This study demonstrates that PD is a safe and recommendable technique that could be routinely performed in TKA.

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Section: Discussionmentioning

confidence: 99%

Effect of Patellar Denervation on Anterior Knee Pain and Knee Function in Total Knee Arthroplasty without Patellar Resurfacing: A Meta‐Analysis of Randomized Controlled Trials

Wang

Feng

Zang

et al. 2020

Orthopaedic Surgery

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“…Overstuffing risks higher joint reaction forces, patella fracture, reduced range of motion and anterior knee pain; understuffing risks a reduction in knee extension strength, extensor lag and instability [ 52 ]. Despite these theoretical risks, recent clinical studies correlating radiographic appearance and clinical outcomes have been mixed [ 53 – 55 ].…”

Section: Resultsmentioning

confidence: 99%

Patella resurfacing during total knee arthroplasty is cost-effective and has lower re-operation rates compared to non-resurfacing

et al. 2021

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Background The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon’s preference, education, training, tradition and geographic location. Advocates for non-resurfacing or selectively resurfacing may claim no difference in patient reported outcomes, and that resurfacing is associated with increased risks such as extensor mechanism injury or malalignment, problems with the design of the patella component and technical issues intraoperatively. Aims To critically examine factors that should be considered in addition to patient reported outcomes in the decision process of resurfacing or non-resurfacing of the patella in total knee arthroplasty. Method A comprehensive literature search was conducted to identify factors that may influence decision making in addition to knee specific patient reported outcome measures such as surgical risks, patient quality of life, procedure cost, re-operation rate, implant design, surgeons learning curve and the fate of remaining cartilage in native patellae. Results Patient-reported outcomes are equivocal for resurfacing and non-resurfacing. Critical analysis of the available literature suggests that the complications of resurfacing the patella are historic, which is now lower with improved implant design and surgical technique. Routine resurfacing was cost-effective in the long term (potential saving £104 per case) and has lower rates of revision (absolute risk reduction 4%). Finally, surgical judgment in selective resurfacing was prone to errors. Conclusion Patella resurfacing and non-resurfacing had similar patient-reported outcomes. However, patella resurfacing was cost-effective and was associated with a lower rate of re-operation compared to non-resurfacing.

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“…Selecting the components of the appropriate size in total knee arthroplasty (TKA) is essential to providing patients with the best possible outcome. Inappropriate component positioning and sizing affects range of motion, soft-tissue balancing, stability, soft-tissue irritation, and impingement [ [1] , [2] , [3] ]. Previous studies have demonstrated that accurate component sizing can be difficult, particularly in women.…”

Section: Introductionmentioning

confidence: 99%

A Surgical Technique to Avoid Mediolateral Overhang during Total Knee Arthroplasty

2021

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Femoral component sizing and positioning is an essential component of performing a successful total knee arthroplasty. Failure to size or position the femoral component correctly can result in reduced range of motion, instability, soft-tissue impingement, and irritation. The following is a description of a novel technique that allows the surgeon to use an intercondylar autograft to translate the femoral component in the mediolateral direction and avoid the consequences of mediolateral femoral component overhang.

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Association Between Femoral Component Sagittal Positioning and Anterior Knee Pain in Total Knee Arthroplasty

Cited by 46 publications

References 27 publications

Effect of Patellar Denervation on Anterior Knee Pain and Knee Function in Total Knee Arthroplasty without Patellar Resurfacing: A Meta‐Analysis of Randomized Controlled Trials

Effect of Patellar Denervation on Anterior Knee Pain and Knee Function in Total Knee Arthroplasty without Patellar Resurfacing: A Meta‐Analysis of Randomized Controlled Trials

Patella resurfacing during total knee arthroplasty is cost-effective and has lower re-operation rates compared to non-resurfacing

A Surgical Technique to Avoid Mediolateral Overhang during Total Knee Arthroplasty

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