Patelloplasty with patellar decompression to relieve anterior knee pain in total knee arthroplasty

Abstract

Objective: Anterior knee pain continues to be an important problem following total knee arthroplasty (TKA). The aim of this study was to present the early results of patelloplasty with patellar decompression to relieve anterior knee pain in patients who undergo TKA.

Methods: We prospectively reviewed 49 knees from 46 patients (35 females, 11 males; mean age: 69.2 years; range: 54 to 82 years) who underwent TKA between January 2004 and December 2008. Decompression and patelloplasty were performed in patients in whom Grade 3 and 4 chondropathy was detected during operation according to the Outerbridge classification. All knees were rated according to the Knee Society Knee and Function Scores, before surgery and during the final follow-up. The patella score was evaluated according to a specific patellofemoral pain questionnaire used by Feller, and the mean knee range of motion was measured preoperatively and postoperatively. Additionally, a patient satisfaction questionnaire used by Levitsky was performed during the final follow-up exam. The mean follow-up period was 41.1 (range: 24 to 68) months.

Results: The mean preoperative and final follow-up knee scores were 48.6 ± 8.8 and 87.70 ± 9.3, and function scores were 48.4 ± 10.4 and 81.4 ± 12.6, respectively. The mean preoperative patellar score was 18.1 ± 3.5, and the final follow-up patellar score was 25.7 ± 2.8. The mean patellar scores were significantly greater in knees with Grade 3 chondropathy compared to Grade 4 chondropathy (26.47 ± 2.38 and 24.29 ± 3.19, respectively). Postoperative anterior knee pain was present in four knees (8.2%). The mean preoperative knee range of motion was 85.1 ± 12.7, and the final follow-up knee range of motion was 117.0 ± 9.8. Patients were "extremely" or "very" satisfied with 93.8% of their operative outcomes on their knees.

Conclusion: Patellar decompression with patelloplasty in TKA is an option for the reduction of anterior knee pain, but there is a lack of significant evidence in the literature, demonstrating that this method is superior to patellar resurfacing and patellar retention.