Meta-Analysis Of Risk Factors For Anterior Knee Pain Following Primary Total Knee Arthroplasty

Objective: A systematic review and meta-analysis was performed to investigate the risks associated with anterior knee pain(AKP)following primary total knee arthroplasty(TKA),and to help prevent the occurrence of AKP after TKA.Methods: A computerized search was performed of the following databases: MEDLINE,Embase,Cochrane Central,CNKI and CBM(published prior to July 2017).StataMP 14.0(Stata Corporation,College Station,TX)were used for all statistical analyses.Results: A total of 37 studies,which included 1641 cases of AKP and 168,090 TKAs,were included in the meta-analysis.A subgroup analysis revealed that compared with those without the following medical conditions,patients who had an Infrapatellar fat pad excision and more than 12 months of follow-up(odds ratio [OR] 12.58,95% confidence interval [CI] 3.245-48.781)were more likely to have AKP after TKA.Circumpatellar electrocautery(>12months: OR 0.50,95% CI 0.326-0.760;?12 months: OR 0.59,95% CI 0.408-0.867)and Patellar resurfacing(OR 0.25,95% CI 0.131-0.485)may decrease the risk of AKP.Other factors,including the prosthesis bearing type(Mobile bearing or Fixed bearing)and the approach(Midvastus compared with the Medial parapatellar approach),were not significant risk factors for AKP.Conclusion: The use of strategies such as patellar denervation and patellar resurfacing in primary TKA is recommended because they are safe and result in good clinical outcomes in preventing AKP.Caution should be taken when using an infrapatellar fat pad excision,because there is an increased risk of AKP at long-term follow-up(>12 months).