Anterior knee pain is a relevant cause for dissatisfaction after total knee arthroplasty without patellar resurfacing

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-08-05 DOI:10.1002/jeo2.70382

Jörg Lützner, Patrick Schubert, Franziska Beyer, Cornelia Lützner

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Abstract

Purpose

The aim of the present study was to investigate the incidence of anterior knee pain (AKP) after total knee arthroplasty (TKA) without patellar resurfacing and to determine how patient-reported outcome measures (PROMs) differ in patients with and without AKP.

Methods

All primary TKAs from the local registry operated on between 2010 and 2016 were reviewed for secondary patellar resurfacing and asked about the presence of AKP (yes/no), satisfaction with the outcome of the TKA (Visual Analogue Scale [VAS] 1–10) and completion of the Oxford Knee Score (OKS) and Anterior Knee Pain Scale (AKPS). A total of 1371 primary TKAs were included, of which 201 patients had died, and 972 (70.9%) completed the additional questionnaires after a mean follow-up of 9.9 years.

Results

AKP was reported by 157 patients (16.2%), and eight patients (0.6%) had undergone secondary patellar resurfacing within two to five years after primary TKA, two of them with an additional increase of the insert due to instability. Patients who reported AKP had significantly worse OKS (mean 24.0 vs. 39.6), AKPS (mean 50.8 vs. 79.1) and satisfaction (mean 4.8 vs. 8.4/10). There were no statistically significant differences in the incidence of AKP by sex (men 15.1% vs. women 16.4%), age at surgery (<60 years 19.6% vs. ≥60 years 15.2%), comorbidities (ASA 1/2 14.5% vs. ASA 3/4 18.1%) and constraint (unconstrained 15.9% vs. rotating-hinge 26.3%). The incidence of AKP in unconstrained TKA was 16.0% in CR, 12.6% in UC and 18.5% in PS implants. AKP occured significantly more frequently in patients with a BMI > 40 kg/m² (26.0%, p = 0.03). In a multivariate regression analysis, only preoperative OKS had an independent influence on AKP (OR 0.949 per point, p = 0.003).

Conclusion

In this study with long-term follow-up, a relevant proportion of patients reported AKP, which had a negative impact on PROMs and satisfaction. However, the rate of secondary patellar resurfacing was very low.

Level of Evidence

Level III, therapeutic study.

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膝关节前侧疼痛是全膝关节置换术后不满意的相关原因

目的：本研究的目的是调查无髌骨表面置换的全膝关节置换术（TKA）后膝关节前侧疼痛（AKP）的发生率，并确定有AKP和没有AKP的患者报告的结果测量（PROMs）的差异。方法回顾2010年至2016年当地登记的所有原发性膝关节置换术患者，并询问他们是否存在AKP（是/否）、对TKA结果的满意度（视觉模拟量表[VAS] 1-10）以及牛津膝关节评分（OKS）和膝关节前痛量表（AKPS）的完成情况。共纳入1371例原发性tka患者，其中201例患者死亡，972例（70.9%）在平均随访9.9年后完成了附加问卷。结果157例（16.2%）患者报告了AKP， 8例（0.6%）患者在原发性TKA后2 - 5年内进行了二次髌骨置换，其中2例由于不稳定而增加了插入物。报告AKP的患者的OKS（平均24.0比39.6）、AKPS（平均50.8比79.1）和满意度（平均4.8比8.4/10）明显较差。性别（男性15.1% vs女性16.4%）、手术年龄（60岁19.6% vs≥60岁15.2%）、合并症（ASA 1/2 14.5% vs ASA 3/4 18.1%）和约束（无约束15.9% vs旋转铰链26.3%）的AKP发生率无统计学差异。无约束TKA的AKP发生率CR为16.0%，UC为12.6%，PS为18.5%。BMI≥40 kg/m2的患者发生AKP的频率更高（26.0%,p = 0.03）。在多元回归分析中，只有术前OKS对AKP有独立影响（OR 0.949 /点，p = 0.003）。结论在本研究的长期随访中，有一定比例的患者报告了AKP，这对PROMs和满意度有负面影响。然而，二次髌骨表面置换术的比例非常低。证据等级：III级，治疗性研究。

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