Length of hospital stay with patient-dependent determination in bilateral scheduled staged total knee arthroplasty

Purpose

The purpose of this study was to approach the length of hospital stay (LOS) by patient-dependent determination and evaluate the effect of contralateral total knee arthroplasty (TKA) on LOS in patients with bilateral osteoarthritis undergoing staged bilateral TKAs.

Methods

One hundred sixty TKAs in 80 patients with bilateral osteoarthritis were evaluated by retrospective review of their medical records. All patients had scheduled staged bilateral TKA. We investigated the length of hospital stay in each TKA and the postoperative day when patients could perform walking and climbing up and down the stairs with one cane independently. Range of motion in each knee was also evaluated in preoperatively and before discharge. The median interval between the first and second surgeries was 12 months.

Results

The first and second TKAs showed a median LOS of 37 and 35 days, respectively, with no significant difference (n.s.). The median number of days before independently walking and climbing up and down the stairs with one cane were 8 and 16 after the first TKA and 7 and 15 after the second TKA, respectively, without significant differences (n.s. for walking, n.s. for stairs).

Conclusions

An initial TKA that results in good function might neither facilitate an earlier second rehabilitation nor decrease the LOS. Taking other factors such economics and local conditions that largely influence LOS into account, simultaneous bilateral TKAs might be an effective treatment for bilateral knee arthritis in properly selected patients in terms of decreasing the LOS.     

Postural stability in relation to anthropometric and functional characteristics in women with knee osteoarthritis following total knee arthroplasty

Introduction

Due to the controversial information about postural stability in patients with lower limb joints osteoarthritis (OA), the following main questions are raised: how serious is the postural stability disturbance and which factors have an impact on postural stability before and after total knee arthroplasty (TKA).

Materials and methods

Force plate was used to assess postural stability and custom-made dynamometer was used to assess isometric maximal voluntary contraction (MVC) force of leg extensor muscles; besides, knee pain and knee range of motion (ROM) was evaluated in 14 female patients (aged 46–68 years) with knee OA 1 day before, and 3 and 6 months following TKA and once in healthy controls (aged 48–70). Relationship between postural stability during standing and selected anthropometric and functional characteristics were investigated with Spearman’s correlation coefficients.

Results

Remarkable reduction of knee pain and improvement in active ROM for the operated leg were shown after unilateral TKA. MVC force of leg extensor muscles achieved the preoperative level half a year after TKA. The centre of pressure (COP) of sway displacement in anterioposterior (AP) and mediolateral direction and the equivalent area of COP sway for the operated leg did not differ before, 3 and 6 months after TKA and compared to the non-operated leg. The trace speed was 6 months after TKA equal to the preoperative level. Only the COP of sway displacement in AP direction is significantly greater in knee OA patients both before and after TKA compared with healthy controls.

Conclusions

Knee OA patients’ postural stability characteristics did not differ significantly both before and after TKA. Compared to healthy controls, the COP of sway displacement in AP direction is mostly disturbed. Correlation analysis confirms that increased postural sway is associated with an increased equivalent area of COP. In knee OA patients higher body mass index ensures reduced trace speed and lower knee ROM.

Level of evidence

Prospective comparative study, Level II.     

Total knee arthroplasty using navigation system for severe osteoarthritis with extra-articular deformity

Purpose

The purpose of this study was to evaluate the use of total knee arthroplasty (TKA) using a computer-assisted navigation system for treating osteoarthritis with extra-articular deformity.

Methods

Between January 2006 and January 2009, computer-assisted navigation TKAs were performed on eight knees in eight patients, who had severe osteoarthritis with an ipsilateral extra-articular deformity. All patients were followed up for a minimum of 24 months. The involved knees were evaluated by function scores, Knee Society knee scores, and analyzing knee flexion before the operation and at the latest follow-up.

Results

Postoperatively, the function scores, Knee Society knee scores, and knee flexion all improved significantly. The ideal mechanical axis of the lower extremity was obtained in all cases.

Conclusion

TKA using a computer-assisted navigation system might provide an efficient treatment for patients with osteoarthritis in combination with an extra-articular deformity.     

In vivo function of posterior cruciate ligament before and after posterior cruciate ligament-retaining total knee arthroplasty

Purpose

The object of this study was to investigate the in vivo function of the posterior cruciate ligament (PCL) in patients before and after a PCL-retaining total knee arthroplasty (TKA).

Methods

Eleven patients with advanced osteoarthritis (OA) of the knee were recruited. Magnetic resonance scans of each OA knee were obtained, and 3D computer models, including the femoral and tibial insertion areas of the anterolateral and posteromedial bundles of the PCL, were created. Before and after PCL-retaining TKA, dual fluoroscopic images of each knee were acquired during weight-bearing knee flexion. The images and computer models were used to reproduce the in vivo motion of the knee. The function of the PCL bundles was described in terms of elongation, elevation and deviation. Twenty-two healthy controls were also included as normal references.

Results

PCL bundles of the OA knees were overstretched during late knee flexion and orientated more medially throughout flexion compared with normal knees. After PCL-retaining TKA, PCL bundles were further overstretched during late flexion and changed from medially directed in normal and OA knees to almost sagittally directed, which may compromise function in controlling knee rotation.

Conclusions

The current PCL-retaining TKA systems and surgical techniques may not adequately re-establish normal biomechanics of PCL bundles after PCL-retaining TKA.     

Total knee arthroplasty of the stiff knee: three hundred and four cases

Purpose

The purpose of this study was to analyse the results of total knee arthroplasty (TKA) in stiff knees (flexion ≤90° and/or flexion contracture ≥20°). Our hypothesis was that despite having poorer results than those obtained in a “standard” population and a high rate of complications, TKA was a satisfactory treatment in patients with osteoarthritis of the knee associated with significant stiffness.

Methods

Three hundred and four consecutive primary HLS TKAs (Tornier), whose data were prospectively collected between October 1987 and October 2012, were retrospectively analysed at a mean of 60 months (range, 12–239) postoperatively. Two groups, those with a “flexion contracture” and those with a “flexion deficit”, were assessed for postoperative range of motion (as integrated to the Knee Society score [KSS]), physical activity level and patient satisfaction.

Results

At the latest follow-up, range of motion was significantly improved, as was the KSS. Ninety-four percent of patients were satisfied or very satisfied, and activity levels were increased after surgery. The complication rate, however, was high in patients with a preoperative flexion deficit (17 %). Pain and residual stiffness were the most common complications.

Conclusion

TKA provides satisfactory results in patients with knee osteoarthritis associated with significant pre-operative stiffness. The surgical plan should be adapted to anticipate complications, which are particularly frequent in the presence of a flexion deficit.     

Total knee arthroplasty: Limb length discrepancy and functional outcome

Background:

Limb length discrepancy and its effects on patient function have been discussed in depth in the literature with respect to hip arthroplasty but there are few studies that have examined the effect on function of limb length discrepency following total knee arthroplasty (TKA). The aim of this study was to determine whether limb length discrepancy after TKA in patients with bilateral osteoarthritis of knee with varus deformity affects functional outcome.

Materials and Methods:

Fifty-four patients with bilateral osteoarthritis of knee with varus deformity, who were operated for total knee arthroplasty from 1996 to 2008, were reviewed retrospectively. The patients were divided into two groups. Thirty patients (mean age 64 years) were operated for unilateral TKA and thirty patients (mean age 65.8 years) were operated for bilateral total knee arthroplasty. Six patients underwent staged surgery and were included in both groups as the time interval between the two surgeries was more than the minimum 6-month follow-up period specified for inclusion in the study. The limb length discrepancy was measured and statistically correlated with the functional component of the Knee Society Score.

Result:

In the unilateral group (n=30), the mean limb length discrepancy was 1.53 cm (range: 0-3 cm) and the mean functional score was 73 (range: 45-100). In the bilateral group (n=30), the mean limb length discrepancy was 0.5 cm (range: 0-2 cm) and the mean functional score was 80.67 (range: 0-100). A statistically significant negative correlation was found between limb length discrepancy and functional score in the unilateral group (Spearman correlation coefficient, r =−0.52, P=0.006), while no statistically significant correlation was found in the bilateral group (Spearman correlation coefficient, r = −0.141, P=0.458).

Conclusion:

Limb length discrepancy affects functional outcome after total knee arthroplasty, especially so in patients of bilateral osteoarthritis with varus deformity undergoing surgery of only one knee.     

Kinematic factors affecting postoperative knee flexion after cruciate-retaining total knee arthroplasty

Purpose

The purpose of this study was to investigate kinematic factors affecting postoperative knee flexion after cruciate-retaining (CR) total knee arthroplasty (TKA) by analysing pre- and postoperative knee kinematics.

Methods

We retrospectively analysed 58 patients with osteoarthritis who received the same implant series. Pre- and postoperative kinematics were measured intraoperatively using a navigation system. As a clinical outcome, we measured the knee flexion angle before and one year after surgery. Correlations among pre- and postoperative kinematics and postoperative flexion were analysed using simple linear regression analyses.

Results

Preoperative knee kinematics, including tibial internal rotation and anterior translation (R?=?0.87, P?<?0.001; R?=?0.53, P?<?0.001, respectively), were significantly correlated with postoperative kinematics. Preoperative varus–valgus movements improved significantly postoperatively; however, tibial internal rotation remained unchanged. Furthermore, postoperative knee flexion angle was significantly correlated with postoperative tibial internal rotation (R?=?0.45, P?<?0.001).

Conclusions

Preoperative knee kinematics were unchanged even after CR-TKA. Postoperative tibial internal rotation is one of the most important factors affecting postoperative knee flexion.     

QCT bone mineral density responses to 1 year of oral bisphosphonate after total knee replacement for knee osteoarthritis

Summary

Bone mineral density (BMD) declined in more than half (53.7%) of post-total knee arthroplasty (TKA) patients (44 of the 82) after 1 year of oral bisphosphonate treatment, and that this decline was significant in bilateral TKA patients.

Introduction

TKA has proven to be an extremely successful procedure in terms of improving ambulatory function. However, the effects of such improvements in ambulatory function and of bisphosphonate on axial BMD have not been established. The purpose of this study was to determine the effect of 1 year of oral bisphosphonate in postmenopausal patients that have undergone TKA and to identify factors related to BMD changes using lumbar spine quantitative computed tomography (QCT).

Methods

Eighty-two postmenopausal women that underwent primary TKA for knee osteoarthritis and who received once-weekly oral alendronate 70 mg for 12 months after TKA were enrolled. The effect of 1 year of oral bisphosphonate treatment post-TKA and the factors related to general lumbar spine BMD changes by using QCT were determined.

Results

Some 53.7% of patients (44 of the 82) experienced an average lumbar spine QCT BMD decline of ?6 mg/ml (range ?15 to ?0.5 mg/ml) after 1 year of oral bisphosphonate treatment, whereas the remaining 38 patients (46.3%) experienced an average increase of 6.8 mg/ml (range 0.6 to 15.7 mg/ml). Logistic and linear regression analysis showed that bilateral TKA was significantly related to a BMD decline (p?<?0.05). Other factors, such as, age, body mass index, number of comorbidities, and Knee Society scores were not found to be significantly related to BMD response.

Conclusions

BMD declined in more than half (53.7%) of the patients after bisphosphonate treatment, and that this decline was significant in bilateral TKA patients. We believe that reduced mobility during rehabilitation was probably responsible for these BMD reductions.     

Feasibility and safety of performing outpatient unicompartmental knee arthroplasty

Purpose

Unicompartmental knee arthroplasty (UKA) has a faster short-term recovery than total knee arthroplasty (TKA). The purpose of this study was to determine the feasibility and safety of performing outpatient UKAs in a consecutive group of patients presenting with unicompartmental knee osteoarthritis.

Methods

A total of 105 consecutive patients underwent unicompartmental arthroplasty before noon with the intention of being discharged as an outpatient. All patients followed an established rapid recovery pathway to facilitate a same-day discharge. Post-operative complications and hospital readmissions were retrospectively recorded for all patients at one week and at three months after surgery.

Results

All of the 105 patients (100 %) indicated for outpatient UKA could be discharged home on the same day of surgery. No patients required readmission within the first week post-operatively, while one patient required readmission between week one and week 12. The single patient who required readmission developed a post-operative infection requiring irrigation/debridement with polyethylene liner exchange and intravenous antibiotics.

Conclusion

Using an established, multidisciplinary, rapid recovery protocol, outpatient UKA is safe and feasible in the vast majority of patients.     

Patient reported outcomes in three hundred and twenty eight bilateral total knee replacement cases (simultaneous versus staged arthroplasty) using the Oxford Knee Score

Purpose

Despite bilateral knee replacement being frequently performed, little data is available to inform on the relative outcomes of each knee for individual patients. The purpose of this study was to compare these outcomes in a series of bilateral total knee replacements (TKRs) performed either simultaneously or at a staged interval.

Methods

We compared outcomes measured by the Oxford Knee Score (OKS; /48) in a series of 656 bilateral TKRs (328 patients). One hundred and fifty-six TKRs were simultaneous and 500 TKRs staged.

Results

Of the staged patients, in 164 (65.6 %) the post-operative OKS in their second TKR matched the first, it was worse in 57 (22.8 %) and better in 29 (11.6 %). The trend was towards a worse OKS in the second staged TKR (p?=?0.003). Mean improvement was similar in simultaneous cases to the first staged TKR (24.3 vs. 24.0; p?=?0.883) but significantly less in second staged TKRs (20.2; p?<?0.001) due to higher pre-operative scores.

Conclusions

Individual patients attained a comparable post-operative score in both their knees, independent of age, pre-operative function and the duration of any staging interval.

     

Long-term subjective outcomes of computer-assisted total knee arthroplasty

Purpose

This study aimed to clarify the results of computer-assisted total knee arthroplasty (TKA) after ten years using patient-derived scores.

Methods

Thirty posterior-stabilised total knee prostheses implanted using a computed tomography-free navigation system were compared with 30 matched total knee prostheses of the same type implanted using a conventional, manual technique. At an average of ten years after surgery, we investigated patient-reported outcomes using the Knee Society’s new scoring system. The results of 27 patients (14 patients in the navigation group and 13 patients in the manual group) were assessed in this study.

Results

There was no significant difference between the navigation and manual groups for any section of the questionnaire, which consisted of symptoms, patient satisfaction, patient expectation, walking/standing, standard activities, advanced activities, and discretionary activities.

Conclusion

After long-term follow-up, we found no subjective advantages of using a navigation system for patients who undergo TKA though the absolute number of patients was very small. Additional extensive studies are required to validate our result.     

Quantitative index for deciding whether to administer preventive anticoagulant therapy in osteoarthritis patients undergoing total knee arthroplasty

Background

The 2008 American Academy of Orthopedic Surgeons recommended that surgeons assess the relative risks of venous thromboembolism and bleeding in patients undergoing total knee arthroplasty (TKA). In this situation, a quantitative index is required for deciding whether to administer preventive anticoagulant therapy for deep venous thrombosis (DVT). In this study, we investigated the risk factors for DVT after TKA.

Methods

We included 102 patients (122 knees) who underwent primary TKA for osteoarthritis of the knee between October 2007 and March 2010. DVT was evaluated using lower limb venous ultrasonography. Cutoff values for individual risk factors were determined using a receiver-operating characteristic analysis, and the patients were grouped according to the cutoff values; the odds ratios (95 % CI) were also investigated. The Wilcoxon signed-rank test and χ ² test were also used.

Results

DVT was positive in 25 knees (20.5 %). Three risk factors for DVT after TKA were identified: age 76 years or older, preoperative maximum soleus vein (MAX-SV) diameter of 6.0 mm or greater, and preoperative D-dimer value of 1.1 μg/dl or higher. The incidence of DVT was significantly higher in the group with two or more risk factors than in the group with one or no risk factors (p = 0.0001).

Conclusions

Development of postoperative DVT correlated significantly with the presence of the following risk factors: age 76 years or older, preoperative MAX-SV diameter of 6.0 mm or greater, and a preoperative D-dimer value of 1.1 μg/dl or higher. Considering the risk–benefit ratio, avoiding preventive anticoagulant therapy following TKA can be an option for patients with osteoarthritis with one or no risk factors.     

Utility of tibial tubercle osteotomy in the setting of periprosthetic infection after total knee arthroplasty

Purpose

This study reports radiographic and clinical treatment outcomes of tibial tubercle osteotomy (TTO) used for two-stage revision total knee arthroplasty (TKA) in the setting of periprosthetic infection.

Methods

Thirty-six patients with 51 TTOs used for infected TKA were retrospectively analysed from 2000 to 2010. In 15 of 36 patients, TTO was used in a sequential manner during both first and second stage procedures. The mean follow-up period was 57?months (range seven–126?months).

Results

The mean pre-operative range of knee motion was 40° (range 10–90°), and at latest follow-up it was 92° (range 50–140°). The Knee Society knee scores and function scores were 47 and 9 pre-operatively and 82 and 72 at latest follow-up, respectively. Bony union was achieved in all cases except one nonunion of an avulsion fragment of the osteotomy segment without functional deterioration.

Conclusions

TTO can be a useful extensile surgical approach for treatment of infected TKA with satisfactory clinical and radiographic outcomes.     

Effect of pulsed electromagnetic field therapy in patients undergoing total knee arthroplasty: a randomised controlled trial

Purpose

It has been reported that even one year after total knee arthroplasty (TKA), a relevant percentage of patients does not attain complete recovery and indicate unfavourable long-term pain outcome. We compared the clinical outcome of 33 patients undergoing TKA randomly assigned to the control or the pulsed electromagnetic field group (I-ONE therapy).

Methods

I-ONE therapy was administered postoperatively four hours per day for 60 days. Patients were assessed before surgery and then at one, two and six months postoperatively using international scores.

Results

One month after TKA, pain, knee swelling and functional score were significantly better in the treated compared with the control group. Pain was still significantly lower in the treated group at the six month follow-up. Three years after surgery, severe pain and occasional walking limitations were reported in a significantly lower number of patients in the treated group.

Conclusions

Advantages deriving from early control of joint inflammation may explain the maintenance of results at follow-up. I-ONE therapy should be considered an effective completion of the TKA procedure.     

Iatrogenic popliteus tendon injury during total knee arthroplasty results in decreased knee function two to three years postoperatively

Purpose

The popliteus tendon is known to play a key role in the stability of the posterolateral corner of the knee. While prior work suggests that isolated sectioning of the popliteus tendon has little consequence for the static stability of the knee following TKA, no studies have evaluated the effect of iatrogenic popliteal tendon injury on patient oriented outcome and knee function following TKA. The aims of this study are (1) to compare patient-oriented outcome scores of patients who suffered an iatrogenic injury to the popliteus tendon with a control group without such an injury and (2) to identify risk factors associated with iatrogenic injury to the popliteus tendon.

Methods

Fifteen patients with an iatrogenic complete transection of the popliteus tendon during TKA were compared to the 666 patients who underwent TKA during the same time period without popliteus tendon injury.

Results

Postoperatively, IKS knee scores were similar between the two groups; however, significantly lower IKS function scores were noted in the study group (71?±?31) compared to the control group (86?±?19) (p?=?0.0036). Iatrogenic popliteal tendon injury was only noted to occur in patients in whom components of size four or smaller were used.

Conclusions

Intraoperative complete section of the popliteus tendon during the performance of TKA results in decreased IKS functional scores two to three?years postoperatively. Patients with smaller knees may be at higher risk for this complication.     

Risk factors for deep infection after total knee arthroplasty: a meta-analysis

Objective

Estimated the risk factors for postoperative infection after total knee arthroplasty (TKA) to prevent its occurrence.

Design

The meta-analysis collected twelve cohorts or case–control studies which included 548 infected persons in 57,223 general cases. Review Manager 5.0 was operated to assess the heterogeneity and to give an overall estimate of the association of factors with postoperative infection after TKA.

Results

The main factors distinctly associated with infection after TKA were BMI (BMI >30: OR = 2.53, 95 % CI 1.25, 5.13; BMI >40: OR = 4.00, 95 % CI 1.23, 12.98), diabetes mellitus (OR = 3.72, 95 % CI 2.30, 6.01), hypertension (OR = 2.53, 95 % CI 1.07, 5.99), steroid therapy (OR = 2.04, 95 % CI 1.11, 3.74), and rheumatoid arthritis (OR = 1.83; 95 % CI 1.42, 2.36). It had no sufficient evidences to reveal that gender could lead to infection after TKA. Osteoarthritis appeared to have a moderately protective effect. Statistical analysis revealed no correlation between urinary tract infection, fixation method, ASA, bilateral operation, age, transfusion, antibiotics, bone graft, and infection.

Conclusion

There were positive evidences for some certain factors which could be targeted for prevention of the onset of infection, but more studies are needed to define the association of some other controversial factors in infection, like osteoarthritis, gender and so on. The quality of studies also needs to be improved.     

Comparing navigation-based in vivo knee kinematics pre- and postoperatively between a cruciate-retaining and a cruciate-substituting implant

Purpose

Individual physiological knee kinematics are highly variable in normal knees and are altered following cruciate-substituting (PS) and cruciate-retaining (CR) total knee arthroplasty (TKA). We wanted to know whether knee kinematics are different choosing two different knee designs, CR and PS TKA, during surgery using computer navigation.

Methods

For this purpose, 60 consecutive TKA were randomised, receiving either CR (37 patients) or PS TKA (23 patients). All patients underwent computer navigation, and kinematics were assessed prior to making any cuts or releases and after implantation. Outcome measures were relative rotation between femur and tibia, measured medial and lateral gaps and medial and lateral condylar lift-off.

Results

We were not able to demonstrate a significant difference in femoral external rotation between either group prior to implantation (7.9° CR vs. 7.4° PS) or after implantation (9.0° CR vs. 11.3° PS), both groups showed femoral roll-back. It significantly increased pre- to postoperatively in PS TKA. In the CR group both gaps increased, the change of the medial gap was significantly attributable to medial release. In the PS group both gaps increased and the change of the medial and of the lateral gap was significant. Condylar lift-off was observed in the CR group during 20° and 60° of flexion.

Conclusion

This study did not reveal significant differences in navigation-based knee kinematics between CR and PS implants. Femoral roll-back was observed in both implant designs, but significantly increased pre- to postoperatively in PS TKA. A slight midflexion instability was observed in CR TKA. Intra-operative computer navigation can measure knee kinematics during surgery before and after TKR implantation and may assist surgeons to optimise knee kinematics or identify abnormal knee kinematics that could be corrected with ligament releases to improve the functional result of a TKR, whether it is a CR or PS design. Our intra-operative finding needs to be confirmed using fluoroscopic or radiographic 3D matching after complete recovery from surgery.     

Change in tibiofemoral rotational alignment during total knee arthroplasty

Background

Rotational mismatch between femoral and tibial components has been recognized as a risk factor of unsuccessful total knee arthroplasty (TKA), but a main cause of rotational mismatch is uncertain. This study aims to evaluate rotational alignment of the knee by measuring both component rotation and version of the knee in TKA.

Method

Fifty-one TKAs (mean age 73.7 years) were included in this study. The three dimensional, weight-bearing knee alignment was measured before and after TKA. A transepicondylar axis was referenced to femoral component rotation, and an anteroposterior axis of the tibia (middle of posterior cruciate ligament attachment to medial border of patella tendon attachment) was referenced to tibial component rotation. Knee rotational angle was defined as the angle between these two axes.

Result

The mean preoperative knee rotation angle of 9.7° (±8.5°) internal rotation was significantly reduced to 1.8° (±7.3°) external rotation after TKA. Twenty-one of 51 knees (41 %) exhibited rotational mismatch (>10°) preoperatively, and this number was reduced to eight knees (16 %) post-TKA. The femoral component was rotationally aligned within 5° of neutral in all knees, while rotational alignment of the tibial component showed a high degree of variability (range 20.7° internal rotation to 17.2° external rotation).

Conclusion

Rotational malposition of the tibial component was considered to be a main factor of rotational mismatch of the knee after TKA.     

The efficacy of patellar decompression for improving anterior knee pain following total knee arthroplasty without patellar resurfacing

Background

Anterior knee pain remains common following total knee arthroplasty (TKA). In this study, we evaluated the efficacy of patellar decompression via drilling for the treatment of anterior knee pain following TKA without patellar resurfacing.

Methods

A prospective cohort study was performed in 271 consecutive patients who underwent primary total knee replacement with patellar decompression (study group, n = 131) or without decompression (control group, n = 140). The patients were assessed according to the Knee Society rating, clinical anterior knee pain score, and British Orthopaedic Association patient-satisfaction score in each group. Each assessment was performed without the examiner knowing whether the patella had been decompressed. Radiographic evaluations were also performed according to the Knee Society scoring system for functional activity and our own severity grade system for patellofemoral articular change.

Results

There were no adverse events following patellar decompression. The overall prevalence of anterior knee pain was not significantly different between groups (p = 0.71). However, patients presenting pain over grade II after the operation in the study group were statistically low (p = 0.01). The overall postoperative knee scores were higher in the study group, but there were no significant differences between groups (p = 0.0731). Analyses of the radiographs revealed similar postoperative outcomes in both groups of knees.

Conclusions

As we observed significantly lower rates of anterior knee pain and no patellar complications following patellar decompression via drilling in TKA without patellar resurfacing, we recommend performing patellar decompression in cases of total knee replacement without patellar resurfacing.