Controversy: supporting patellar resurfacing in total knee arthroplasty – do it

Benazzo, Francesco; Perticarini, Loris; Jannelli, Eugenio; Ivone, Alessandro; Ghiara, Matteo; Rossi, Stefano Marco Paolo

doi:10.1302/2058-5241.5.190075

Cited by 25 publications

(15 citation statements)

References 44 publications

(21 reference statements)

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“…It improves the treatment quality and increases hospital profit with efficient bed management [ 12 ]. LOS may be influenced by several factors, including patient characteristics (age, gender, BMI, comorbidities, the American Society of Anesthesiologists (ASA) classification); perioperative management (anesthesia type, blood management) [ 13 ], surgical characteristics (approach, prosthesis design,duration time) [ 14 – 16 ], postoperative management (mobilization timing, postoperative pain) [ 17 – 21 ], and postoperative complication before discharge (infection, deep vein thrombosis) [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Association between type of anesthesia and length of hospital stay in primary unilateral total knee arthroplasty patients: a single-center retrospective study

Wang

Yuan

et al. 2021

J Orthop Surg Res

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Objective This study explored the risk factors influencing the length of hospital stay (LOS) and establish whether the type of anesthesia is independently associated with the LOS in patients after primary unilateral total knee arthroplasty (TKA). Methods In this retrospective cohort study, 2309 patients undergoing unilateral TKA were recruited between January 2013 and June 2014 in a tertiary academic medical center in Singapore. Univariate and multivariate linear regression analyses were used to identify the independent risk factors associated with LOS. Besides, subgroup and interaction analyses were performed to evaluate the relationship between the type of anesthesia and LOS. Result In total, 2309 patients were identified. Out of these, 791 patients underwent general anesthesia, whereas 1518 patients underwent regional anesthesia. Multivariate regression analyses revealed that prolonged LOS was significantly associated with age ≥ 65 years (β = 0.48; 95% CI, 0.09–0.87; P = 0.015), diabetes mellitus (DM) (β = 0.8; 95% CI, 0.33–1.27; P = 0.001), congestive cardiac failure (CCF) (β = 4.1; 95% CI, 2.02–6.17; P < 0.001), perioperative blood transfusion (β = 5.71; 95% CI, 4.86–6.56; P < 0.001), creatinine > 2 mg/dL (β = 4.54; 95% CI, 2.46–6.62; P < 0.001), ASA status (III) (β = 1.72; 95% CI, 0.72–2.71; P = 0.001), general anesthesia (β = 0.78; 95% CI, 0.41–1.66; P < 0.001). The LOS further decreased among participants receiving regional anesthesia at advanced age (age ≥ 65 years) (β = − 1.12; 95% CI, − 1.66 to − 0.58; P < 0.001), patients with BMI ≤ 25 kg/m2 (β = − 1.92; 95% CI, − 2.73 to − 1.11; P < 0.001) or ≥ 30 kg/m2 (β = − 0.58; 95% CI, − 1.1 to − 0.06; P = 0.029). Conclusion Our findings demonstrated that age ≥ 65 years, DM, CCF, perioperative blood transfusion, creatinine > 2 mg/dL, ASA status (III), general anesthesia are associated with a prolonged LOS after primary TKA. Elderly patients (age ≥ 65 years) and patients with BMI ≤ 25 kg/m2 or ≥ 30 kg/m2 receiving regional anesthesia have a further reduced LOS. Therefore, when TKA is performed, priority for regional anesthesia is given to the elderly patients (age ≥ 65 years old) and those with BMI ≤ 25 kg/m2 or ≥ 30 kg/m2.

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Section: Introductionmentioning

confidence: 99%

Association between type of anesthesia and length of hospital stay in primary unilateral total knee arthroplasty patients: a single-center retrospective study

Wang

Yuan

et al. 2021

J Orthop Surg Res

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“…Patellar replacement can improve knee function by restoring the natural movement of the patella. This can reduce pain and stiffness in the knee joint and improve the ability to perform daily activities (18,19) .…”

Section: Methodsmentioning

confidence: 99%

Outcomes of Patellar Replacement Vs Patellar Neurectomy in Total Knee Replacement

Dar¹,

Shahid²,

Muqaddas³

et al. 2023

PJMHS

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Objectives: To compare the outcomes of patellar replacement and patellar neurectomy in Patients undergoing Total Knee Replacement . Materials & Methods: The design of this study was a cross sectional study design and this study was conducted in DHQ Teaching Hospital Gujranwala. Total 30 Patients were enrolled in this study and they were divided into two groups. Group A constitutes of 15 Patients underwent Post tibial neurectomy. And Group B consisting of 15 Patients went through Tibial Resection. All the patients have been assessed through the Tinel test on the painful area and self-administered Patient-Reported Outcome Measurements (PROMs): Patellar replacement also known as patellofemoral arthroplasty, is a surgical procedure that is performed in conjunction with total knee replacement (TKR) to relieve pain in the knee joint caused by patellofemoral arthritis or other conditions affecting the patella. All the patients of Group B were given anesthesia to numb the area. An incision was made in front of the knee to expose the patella and surrounding structures. Removal of the patella: The patella was carefully removed from the knee joint. The underside of the patella was reshaped to fit a prosthetic component that was implanted in its place. The patellar component was attached to the reshaped surface of the patella using bone cement. The patella was repositioned in the knee joint and attached to the femur using sutures. The incision was closed using sutures or staples. The goal of patellar replacement is to reduce pain and improve function in the knee joint. All the group A participants went through Patellar neurectomy. Patellar neurectomy is a surgical procedure that involves cutting or removing the nerve endings that supply sensation to the patella. Results: Total 30 Patients participated in this study. In Group A =15 Patients who underwent patellar Neurectomy and 15 Patients in Group B who experienced Tibia Resection. Total 5 months follow up was done. Group B participants showed excellent Results. NRS score decreased to 0 in Group B. While in patellar Neurectomy group A two patients experienced still moderate pain, Remaining 13 patients although did not experienced pain but felt numbness on limbs. Practical Implication: Patellar neurectomy involves cutting or removing the nerve endings that supply sensation to the patella, interrupting the transmission of pain signals from the patella to the brain. Although it is less time consuming but can cause numbness or altered sensation in the skin over the patella, which may affect the patient's quality of life Does not address underlying patellar instability or misalignment, which can still cause pain and functional limitations Can be associated with a risk of complications such as neuroma, infection, stiffness. Conclusion: Patellar Resection with TKA has better outcomes than Patellar Neurectomy. Patellar denervation with electrocautery is effective in reducing pain and opioid consumption after total knee replacement. Postoperative range of motion is significantly better in patellar denervation group, which means that patellar denervation significantly improves clinical outcome Keywords: Total Knee Replacement, Patellar Replacement, Neurectomy, Neurectomy, Tibia Resection, Pain, Prosthesis

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“…There is controversy as to whether the patella should be replaced with a patella button in primary TKA [ 6 , 7 , 8 , 9 , 10 ]. In the United States (US), >90% of primary TKA are performed with patellar resurfacing [ 6 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Secondary Patellar Resurfacing in TKA: A Combined Analysis of Registry Data and Biomechanical Testing

Bauer¹,

Woiczinski²,

Thorwächter³

et al. 2021

JCM

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The German Arthroplasty registry (EPRD) has shown that different prosthesis systems have different rates of secondary patellar resurfacing: four years after implantation, the posterior-stabilized (PS) Vega prosthesis has a 3.2% risk of secondary patellar resurfacing compared to the cruciate-retaining (CR) Columbus prosthesis at 1.0% (both Aesculap AG, Tuttlingen, Germany). We hypothesized that PS implants have increased retropatellar pressure and a decreased retropatellar contact area compared to a CR design, which may lead to an increased likelihood of secondary patellar resurfacing. Eight fresh frozen specimens (cohort 1) were tested with an established knee rig. In addition, a possible influence of the registry-based patient collective (cohort 2) was investigated. No significant differences were found in patient data–cohort 2-(sex, age). A generally lower number of PS system cases is noteworthy. No significant increased patella pressure could be detected with the PS design, but a lower contact area was observed (cohort 1). Lower quadriceps force (100°–130° flexion), increased anterior movement of the tibia (rollback), greater external tilt of the patella, and increasing facet pressure in the Vega PS design indicate a multifactorial cause for a higher rate of secondary resurfacing which was found in the EPRD patient cohort and might be related to the PS’ principle function.

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Controversy: supporting patellar resurfacing in total knee arthroplasty – do it

Cited by 25 publications

References 44 publications

Association between type of anesthesia and length of hospital stay in primary unilateral total knee arthroplasty patients: a single-center retrospective study

Association between type of anesthesia and length of hospital stay in primary unilateral total knee arthroplasty patients: a single-center retrospective study

Outcomes of Patellar Replacement Vs Patellar Neurectomy in Total Knee Replacement

Secondary Patellar Resurfacing in TKA: A Combined Analysis of Registry Data and Biomechanical Testing

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