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Circumpatellar electrocautery may lead to lower rate of knee pain 1 year after TKA
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SAN DIEGO — Patients who underwent circumpatellar electrocautery during total knee arthroplasty performed without patellar resurfacing had a lower rate of anterior knee pain at 1 year compared with those not treated with electrocautery, according to a study presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.
Hans Peter W. Van Jonbergen, MD, of Deventer, Netherlands, and colleagues conducted a prospective, blinded clinical trial in 2008 to determine the prevalence of anterior knee pain after total knee arthroplasty (TKA) performed with and without circumpatellar electrocautery. None of the patients studied underwent patellar resurfacing. Van Jonbergen noted that the overall prevalence of knee pain in study at 1 year was 26%.
“The results of our randomized controlled trial showed that electrocautery of the patellar rim in total knee replacement without patellar resurfacing results in a lower prevalence of anterior knee pain at 1-year follow-up,” Van Jonbergen said.
The study included an original cohort of 300 patients. All patients underwent the same TKA protocols and received the same prosthesis design. Surgeons cemented the tibial and femoral components in each group, Van Jonbergen said, noting that patient randomization occurred after the implants were placed.
Investigators followed the groups for 1 year and used their anterior knee pain, as rated by a clinician blinded to group allocation, to assess the prevalence of pain. At final follow-up, 131 patients remained in each group.
“A possible explanation for our results would be that electrocautery of the patellar rim leads to partial denervation in the anterior knee. By this mechanism, patellar resurfacing may also result in partial denervation,” Van Jonbergen said.
He noted the 1-year follow-up as the main limitation of the study.
“As the effect of denervation may diminish over time, we will re-evaluate our patients. Furthermore, the clinical relevance is unclear at the present,” Van Jonbergen said.
Reference:
- Van Jonbergen HPW, Scholtes VA, Van Kampen A, Poolman RW. Lower prevalence of anterior knee pain in total knee arthroplasty with circumpatellar electrocautery. Paper #407. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19, 2011. San Diego.
Disclosure: He has no relevant financial disclosures.
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