Does circumpatellar electrocautery improve the outcome after total knee replacement?

A prospective, randomised, blinded controlled trial

S. Baliga, C. J. McNair, K. J. Barnett, J. MacLeod, R. W. Humphry, D. Finlayson

Abstract

The incidence of anterior knee pain following total knee replacement (TKR) is reported to be as high as 49%. The source of the pain is poorly understood but the soft tissues around the patella have been implicated.

In theory circumferential electrocautery denervates the patella thereby reducing efferent pain signals. However, there is mixed evidence that this practice translates into improved outcomes.

We aimed to investigate the clinical effect of intra-operative circumpatellar electrocautery in patients undergoing TKR using the LCS mobile bearing or Kinemax fixed bearing TKR. A total of 200 patients were randomised to receive either circumpatellar electrocautery (diathermy) or not (control). Patients were assessed by visual analogue scale (VAS) for anterior knee pain and Oxford knee score (OKS) pre-operatively and three months, six months and one year post-operatively. Patients and assessors were blinded.

There were 91 patients in the diathermy group and 94 in the control. The mean VAS improvement at one year was 3.9 in both groups (control; -10 to 6, diathermy; -9 to 8, p < 0.001 in both cases, paired, two-tailed t-test). There was no significant difference in VAS between the groups at any other time. The mean OKS improvement was 17.7 points (0 to 34) in the intervention group and 16.6 (0 to 42) points in the control (p = 0.36). There was no significant difference between the two groups in OKS at any other time.

We found no relevant effect of patellar electrocautery on either VAS anterior knee pain or OKS for patients undergoing LCS and Kinemax TKR.

Footnotes

  • Financial grants from Corin, Stryker and DePuy supported the Raigmore Arthroplasty team (KB & JMacL). No other benefits have been received in respect of this work. The authors would like to thank their consultant colleagues at Raigmore, all of whom willingly contributed to the trial. They also acknowledge the help given by J. Simpson and J. Beastall.

    The author or one or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article.

  • Received June 15, 2011.
  • Accepted April 2, 2012.
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