Patellofemoral resurfacing and patellar denervation in primary total knee arthroplasty

Verfasser / Beitragende:
[Alisara Arirachakaran, Chanchit Sangkaew, Jatupon Kongtharvonskul]
Ort, Verlag, Jahr:
2015
Enthalten in:
Knee Surgery, Sports Traumatology, Arthroscopy, 23/6(2015-06-01), 1770-1781
Format:
Artikel (online)
ID: 605456372
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024 7 0 |a 10.1007/s00167-014-3311-z  |2 doi 
035 |a (NATIONALLICENCE)springer-10.1007/s00167-014-3311-z 
245 0 0 |a Patellofemoral resurfacing and patellar denervation in primary total knee arthroplasty  |h [Elektronische Daten]  |c [Alisara Arirachakaran, Chanchit Sangkaew, Jatupon Kongtharvonskul] 
520 3 |a Purpose: To conduct a systematic review and network meta-analysis of randomized controlled trials (RCTs) with the aim of comparing relevant clinical outcomes between patellar denervation, resurfacing and non-resurfacing. Methods: A database search was performed using PubMed and Scopus search engines. RCTs or quasi-experimental designs comparing clinical outcomes between treatments by a search of articles dated from inception to October 23, 2012. Unstandardized mean difference (UMD) and random effects methods were applied for pooling continuous and dichotomous outcomes, respectively. A longitudinal mixed regression model was used for network meta-analysis to indirectly compare treatment effects. Results: Eighteen of 315 studies identified were eligible. Compared with patellar non-resurfacing, patellar denervation had a UMD that displayed a significant improvement in symptoms with values in pain visual analog score (VAS) and Knee Society Score (KSS) of −0.6 [95% confidence interval (CI) −1.13, −0.25] and 2.55 (95% CI 0.43, 4.68), respectively. The UMD in VAS, KSS, and Knee Function Score (KFS) in patellar resurfacing showed no significant improvement in symptoms when compared to non-resurfacing. Patients who underwent surgery with patellar resurfacing had a lower reoperation rates with pooled relative risks (RRs) of 0.69 (95% CI 0.50, 0.94) when compared to non-resurfacing. The network meta-analysis suggested a benefit of borderline significance for patellar denervation with a pooled RR of 0.63 (95% CI 0.38, 1.03), showing that there is a lower chance of anterior knee pain when compared to non-resurfacing. Patellar resurfacing also displays a significantly lower chance of reoperation with a pooled RR of 0.68 (95% CI 0.50, 0.92) when compared to non-resurfacing. Multiple active treatment comparisons indicated that patellar denervation resulted in greater improvement in KFS than patellar resurfacing. Conclusion: This review suggests that either patellar denervation or patellar resurfacing may be selected for the management of the patellofemoral component in total knee replacement. Patellar denervation may help improve postoperative knee function, but does not improve pain when compared to patellar resurfacing. 
540 |a European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA), 2014 
690 7 |a Circumferential electrocautery  |2 nationallicence 
690 7 |a Patellar denervation  |2 nationallicence 
690 7 |a Resurfacing  |2 nationallicence 
690 7 |a Non-resurfacing  |2 nationallicence 
690 7 |a Network meta-analysis  |2 nationallicence 
700 1 |a Arirachakaran  |D Alisara  |u Orthopedics Department, Police General Hospital, Bangkok, Thailand  |4 aut 
700 1 |a Sangkaew  |D Chanchit  |u Orthopedics Department, Police General Hospital, Bangkok, Thailand  |4 aut 
700 1 |a Kongtharvonskul  |D Jatupon  |u Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand  |4 aut 
773 0 |t Knee Surgery, Sports Traumatology, Arthroscopy  |d Springer Berlin Heidelberg  |g 23/6(2015-06-01), 1770-1781  |x 0942-2056  |q 23:6<1770  |1 2015  |2 23  |o 167 
856 4 0 |u https://doi.org/10.1007/s00167-014-3311-z  |q text/html  |z Onlinezugriff via DOI 
898 |a BK010053  |b XK010053  |c XK010000 
900 7 |a Metadata rights reserved  |b Springer special CC-BY-NC licence  |2 nationallicence 
908 |D 1  |a review-article  |2 jats 
949 |B NATIONALLICENCE  |F NATIONALLICENCE  |b NL-springer 
950 |B NATIONALLICENCE  |P 856  |E 40  |u https://doi.org/10.1007/s00167-014-3311-z  |q text/html  |z Onlinezugriff via DOI 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Arirachakaran  |D Alisara  |u Orthopedics Department, Police General Hospital, Bangkok, Thailand  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Sangkaew  |D Chanchit  |u Orthopedics Department, Police General Hospital, Bangkok, Thailand  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Kongtharvonskul  |D Jatupon  |u Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand  |4 aut 
950 |B NATIONALLICENCE  |P 773  |E 0-  |t Knee Surgery, Sports Traumatology, Arthroscopy  |d Springer Berlin Heidelberg  |g 23/6(2015-06-01), 1770-1781  |x 0942-2056  |q 23:6<1770  |1 2015  |2 23  |o 167