Patellar Denervation with Electrocautery Reduces Anterior Knee Pain within 1 Year after Total Knee Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

Abstract

Objective The effect of patellar denervation with electrocautery (PD) on anterior knee pain (AKP) after total knee arthroplasty (TKA) is still debated. The aim of this meta‐analysis was to evaluate the current evidence regarding the use of PD in TKA without patellar resurfacing. Methods A computerized search of published studies was performed in the PubMed, Embase and Cochrane Library databases in December 2019. Eligible studies were randomized controlled trials (RCTs) comparing clinical outcomes of the PD group and the non‐PD group. Subgroup analyses were carried out according to the follow‐up time (3, 12 months, and over 12 months) to evaluate whether the clinical effect of PD changed with time. Results Ten RCTs were included in this meta‐analysis. Pooled results showed a lower rate of AKP (Risk Ratio [RR] = 0.70; 95% confidence interval [CI], 0.50 to 0.97; P = 0.03) and a reduction in visual analogue scale (VAS) for AKP (mean difference, −0.37; 95% CI, −0.69 to −0.05; P = 0.02) in the PD group when compared to the non‐PD group. Subgroup analyses found the differences in AKP incidence and VAS for AKP were significant at 3‐ and 12‐month follow‐up but not after 12‐month follow‐up. No significant difference was observed in functional scores between the two groups. No specific complication directly or indirectly related to PD was found. Conclusion PD can decrease the incidence and severity of AKP within 12 months after TKA, but the effect cannot be maintained after 12‐month follow‐up. Without significant associated complication and reoperation, the use of PD is still recommended in TKA without patellar resurfacing.

Keywords

• Anterior knee pain
• Meta‐analysis
• Patellar denervation with electrocautery
• Total knee arthroplasty