CIRCUMPATELLAR ELECTROCAUTERY IN TOTAL KNEE REPLACEMENT WITHOUT PATELLAR RESURFACING 1059
VOL. 93-B, No. 8, AUGUST 2011
patients. It has been suggested that a fixed design may be
associated with a higher incidence of anterior knee pain
than a mobile-bearing prosthesis.
We undertook TKR
without patellar resurfacing, since definite evidence for its
use is lacking.
The manner by which circumpatellar electrocautery
results in a reduced rate of anterior knee pain may be desen-
sitisation or denervation of the pain receptors in the anterior
This mechanism could be operating in the different
procedures collectively described as patelloplasty. Since
patellar resurfacing requires removal of osteophytes and
synovial tissue to allow accurate resection and restore patel-
lar thickness, this may at least in part result in denervation.
Gupta et al
reported a lack of improvement after patel-
lar rim electrocautery at a minimum of two years following
TKR without patellar resurfacing when using the rotating-
platform, mobile-bearing Low Contact Stress total knee
prosthesis (LCS; DePuy International, Leeds, United King-
dom). This alone may account for the lower incidence of
anterior knee pain compared with the posterior-stabilised,
fixed-bearing NexGen prosthesis used in our study.
their patients had not been randomised, but were matched
Whether this difference arises from our
relatively short follow-up warrants further attention. Some
have reported a gradual decrease in anterior
knee pain after TKR, whereas others have described an
increase over time.
In order to assess the long-term out-
come, we will re-evaluate our patients to determine
whether the clinical effect of circumpatellar electrocautery
diminishes with time.
In summary, the results of our randomised, controlled
trial at one year show that circumpatellar electrocautery in
TKR without patellar resurfacing results in a lower inci-
dence of anterior knee pain and better WOMAC scores
compared with no circumpatellar electrocautery.
Listen to the abstract of this article at
We wish to thank members of the Anterior Knee Pain Study Group (A. F. W. Bar-
naart, R. H. G. P. van Erve, H. P. W. van Jonbergen, A. van Kampen, R. Koorevaar,
D. D. Langeloo, R. W. Poolman and D. M. Werkman) and Mrs I. Wippert for her
invaluable assistance in evaluating the patients and co-ordinating the knee
replacement integrated care pathway.
No benefits in any form have been received or will be received from a com-
mercial party related directly or indirectly to the subject of this article.
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