The Effect Of Patellar Denervation In Primary Total Knee Arthroplasty Without Patellar Resurfacing: A Meta Analysis

Objective: To evaluate the effect of patellar denervation in primary total knee arthroplasty(TKA)without patellar surfacing using meta-analysis.Methods: Inclusion and exclusion criteria were based on PICO principle(Participant,Intervention,Comparator,Outcome).All public relevant randomized controlled trials were retrieved in a computerized search of Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, wanfang Data system, VIP,China Biomedical Database and google scholar. Two investigators filtered the literature, evaluated the retrieved RCTs and collected data independently. The quality assessment of RCTs were based on Jadad scale and allocation concealment classification from Cochrane Library. The outcome indicators included incidence of anterior knee pain, Visual Analogue Scale, feller patellar score, Knee Society clinical Score、Knee Society function Score, range of motion, the incidence of infection and complications. All analyses were completed with Review Manager Software 5.3. For dichotomous data, relative risk(RR) and 95% confidence interval(CI) were calculated, while for continuous variables, weighted mean difference(WMD) and 95% confidence interval(CI) were calculated. Heterogeneity test was conducted before data merging: if I2 < 50%, the Fixed-effect model was Applied; if I2 ≥50%,the random-effect model was applied.Results: 453 literature were retrieved and 6 randomized control trials( RCTs) met the inclusion criteria and were included in this meta-analysis. A total of 723 knees was included, of which 362 knees in experimental group(denervation group) and 361 knees in control group(no denervation group).The quality of included RCTs were relatively high,and the baseline characteristic of RCTs was balance. According to results of this meta-analysis, the outcomes of the experimental group were significantly better than that of control group for the incidence of anterior knee pain, feller patellar score, Knee Society knee score, Knee Society function score, range of motion. But, the differences between the experimental group and the control group were not significant for Visual Analogue Scale, the incidence of infection and complications.Conclusion: The results of meta-analysis demonstrated that the patellar denervation in primary TKA without patellar resurfacing, can reduce the incidence of anterior knee pain, improve the clinical outcome and it was relatively safe in early follow-up.