Electrocautery of the patellar rim in primary total knee replacement: beneficial or unnecessary?

Abstract

The management of the patella during total knee replacement is controversial. In some studies the absence of patellar resurfacing results in residual anterior knee pain in over 10% of patients. One form of treatment which may be used in an endeavour to reduce this is circumferential patellar rim electrocautery. This is believed to partially denervate the patella. However, there is no evidence of the efficacy of this procedure, nor do we know if it results in harm. A retrospective comparative cohort study was performed of 192 patients who had undergone a primary total knee replacement with the porous coated Low Contact Stress rotating platform prosthesis without patellar resurfacing between 2003 and 2007. In 98 patients circumferential electrocautery of the patellar rim was performed and in 94 patients it was not. The two groups were matched for gender and age. The general Oxford Knee Score and the more specific patellar score for anterior knee pain were used to assess patient outcomes a minimum of two years post-operatively. No statistically significant differences were noted between the groups for either scoring system (p = 0.41 and p = 0.87, respectively). Electrocautery of the patella rim did not improve the outcome scores after primary total knee replacement in our patients.

The Effect of Electrocautery around the Patellar Rim in Patellar Non-Resurfacing Total Knee Arthroplasty

“…In an attempt to interrupt these potential pain pathways, Gupta et al12) performed patellar rim cauterization. Some authors associated peripatellar soft tissues and infrapatellar fat pad with anterior knee pain20,21).…”

“…However, there have been no studies documenting favorable results of patellar rim electrocautery in TKA12). Considering that pain is a subjective symptom, it is difficult to make an accurate assessment on patellofemoral joint pain.…”

“…Contrary to the study by Gupta et al12) where the efficacy of electrocautery was evaluated in patients with unilateral TKA, we enrolled patients with patellar non-resurfacing bilateral TKA and performed electrocautery randomly on one side to improve the accuracy of the evaluation.…”

“…van Jonbergen et al11) employed circumpatellar electrocautery to reduce anterior knee pain in 56% of the non-resurfaced patellae and in 32% of the resurfaced patellae in TKA. In addition, Gupta et al12) investigated the efficacy of electrocautery in anterior knee pain reduction. The purpose of our study was to assess the influence of electrocautery on pain reduction in patients who underwent patellar non-resurfacing bilateral TKA.…”

Arthroscopic patellofemoral denervation in the treatment of severe patellofemoral arthritis

“…Because the operation cannot repair the cartilage, the pathological basis of osteoarthritis always exist, the lateral patellar formation combined with the lateral patellar retinaculum release had no definite curative effect [10,11]. Some scholars have been able to alleviate the symptoms by arthroscopic radiofrequency ablation of the patellofemoral joint to block the pain pathway [13].…”