Prevalence of anterior knee pain after patellar retention total knee arthroplasty: Comparison of patients with rheumatoid arthritis versus primary osteoarthritis

Aug 26, 2019Acta orthopaedica et traumatologica turcica

How common front knee pain is after knee replacement with patella kept, comparing rheumatoid arthritis and osteoarthritis patients

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Abstract

The frequency of anterior knee pain (AKP) was 8% in patients with osteoarthritis (OA) and 7% in patients with rheumatoid arthritis (RA) following total knee arthroplasty (TKA) without patellar resurfacing.

Both groups showed significant improvement in knee function, with the International Knee Documentation Committee (IKDC) score increasing to approximately 85 for both OA and RA patients postoperatively.
The mean Knee Society Score (KSS) improved from around 28 preoperatively to approximately 90 postoperatively for both groups.
Patients in both groups reported substantial enhancement in their quality of life, as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, which rose to about 96.
Range of motion (ROM) improved significantly in both groups, with OA patients achieving an average of 113.17° and RA patients an average of 112.8° postoperatively.
The severity of AKP among those who experienced it was similar between both groups, with mean AKP Scale scores close to 93.

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OBJECTIVE: The aim of this study was to investigate whether there is an increased risk of anterior knee pain (AKP) after total knee arthroplasty (TKA) without patellar resurfacing in patients with rheumatoid arthritis (RA) versus primary osteoarthritis (OA).

METHODS: This study was a retrospective review of 388 patients (577 knees) who underwent TKA without patellar resurfacing between 2003 and 2011, with a minimum of 5 years of follow-up. Patients were divided into two groups: Group OA (273 knees of 206 patients; 83 males, 123 females; mean age: 64.4 (47-87) years) and Group RA (304 knees of 182 patients; 92 males, 90 females; mean age: 50.7 (21-72) years). In the clinical evaluation, the knee range of motion (ROM) and several outcome measures such as The Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and International Knee Documentation Committee (IKDC) scores were used preoperatively and at the final follow-up visit. The quality of life was measured using Short Form (SF)-36 MCS and PCS scores. The primary outcome was the frequency and severity of patient-reported AKP. The AKP Scale was used to determine the severity of AKP.

RESULTS: The IKDC raised from 21.62 (range, 13-29.9) preoperatively to 85.1 (range, 80-88) for group OA and from 21.8 (range, 13-29.9) to 85.2 (range, 81-88) for group RA (p < 0.001). The mean KSS improved from 28.35 (range, 22-38) preoperatively to 90.04 (range, 88-95) for group OA and from 21.9 (range, 18-35) preoperatively to 89.7 (range, 86-95) for group RA. The mean WOMAC increased from 20.61 (range, 17.4-24.2) preoperatively to 95.7 (range, 90.9-97.7) for group OA (p < 0.001) and from 20.2 (range, 16.7-24.2) preoperatively to 95.8 (range, 90.9-98.5) for group RA (p < 0.001). The mean ROM improved from 80.14° (range, 55°-130°) preoperatively to 113.17° (range, 95°-140°) in group OA (P = 0.003) and from 73.4° (range, 10°-130°) to 112.8° (range 90°-140°) in group RA (P = 0.003) postoperatively. The frequency of AKP was 8% in Group OA and 7% in Group RA (p = 0.27). For patients with AKP, the mean AKP Scale was 92.74 (range, 84-98) in Group OA and 93.39 (range, 82-98) in Group RA (p = 0.3).

CONCLUSION: After TKA without resurfacing the patella, patients with RA were determined to have a similar risk for AKP as those with OA.

LEVEL OF EVIDENCE: Level III, Therapeutic Study.

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Prevalence of anterior knee pain after patellar retention total knee arthroplasty: Comparison of patients with rheumatoid arthritis versus primary osteoarthritis

Abstract

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