Denervation of the Patella During Knee Arthroplasty: An Updated Systematic Global Review.

Abstract

Background: Total knee arthroplasty is a widely endorsed surgical intervention, extensively recognized within the orthopedic field for its efficacy in significantly reducing pain and enhancing overall mobility in patients suffering from advanced stages of osteoarthritis. Despite a general consensus on the core procedural steps, the rapid advancements in implant technology and the nuanced techniques in knee reconstruction have inevitably introduced subtle variations in surgical approaches. These variations often emerge due to individual surgeon preferences, their unique expertise, and comfort levels with specific techniques. Anterior knee pain, however, remains a frequent postoperative complication, likely attributed to the extensive and complex innervation of the patella. To address this challenge, some surgeons have adopted patellar denervation, hypothesizing that by reducing nerve signaling from the patellar region, patients may experience a measurable decrease in pain. Methods: A systematic search was performed to include eight recent level I studies to analyze this issue. Results: Of the eight reviews, there were four strong studies that concluded patellar denervation helps decrease anterior knee pain in the acute period, but this may not last long term. The other four papers did not show a difference in anterior knee pain after denervation. Conclusions: This review synthesizes and critically analyzes the current body of literature, aiming to provide clinicians with evidence-based insights into the potential benefits and limitations of incorporating patellar denervation into their surgical especially during the acute post-operative period.