Niloofar Namazi1, Fereidoon Mojtahed Jaberi1, Sara Pakbaz2, Amir Reza Vosoughi3, Mahrad Mojtahed Jaberi4. 1. Bone and Joint Disease Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. 2. Department of Pathology, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. 3. Bone and Joint Disease Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: vosoughiar@hotmail.com. 4. McGill University, Montreal, Quebec, Canada.
Abstract
BACKGROUND: Circumpatellar electrocauterization to destroy pain receptors during total knee arthroplasty without patellar resurfacing is commonly used to decrease postoperative knee pain. We aimed to evaluate the effect of denervation with electrocauterization on patellar cartilage. METHODS: Twenty rabbits were randomly assigned to two equally sized case and control groups. The rabbits in the case group underwent surgery via the anterior midline skin incision and medial parapatellar arthrotomy, followed by denervation electrocauterization at a depth of 1 mm and a distance of 3 mm from the outer border of the patella. In the control group, surgery was identical to that performed in the case group, but without patellar denervation. Twelve weeks after surgery, all rabbits were sacrificed. Range of motion, macroscopic evaluation of cartilage using modified Outerbridge scoring, and histopathological assessment using a modified histologic scoring system for cartilage were evaluated. RESULTS: Three rabbits died during the study. Nine cases and eight animals from the control group were included in the final evaluation. All rabbits had passive full range of motion. Mean Outerbridge score was 2.0 in the case group and 0.37 in the control group (p=0.002). There were statistically significant differences in cellularity (p=0.016), loss of matrix (p=0.004), and clustering of chondrocytes (p=0.008) between the two groups. Microscopic variables as a whole were statistically significant (p=0.001). CONCLUSIONS: Circumpatellar electrocauterization may result in cartilage destruction. So, we encourage caution in using routine electrocauterization in patients undergoing total knee arthroplasty. LEVEL OF EVIDENCE: level II.
BACKGROUND: Circumpatellar electrocauterization to destroy pain receptors during total knee arthroplasty without patellar resurfacing is commonly used to decrease postoperative knee pain. We aimed to evaluate the effect of denervation with electrocauterization on patellar cartilage. METHODS: Twenty rabbits were randomly assigned to two equally sized case and control groups. The rabbits in the case group underwent surgery via the anterior midline skin incision and medial parapatellar arthrotomy, followed by denervation electrocauterization at a depth of 1 mm and a distance of 3 mm from the outer border of the patella. In the control group, surgery was identical to that performed in the case group, but without patellar denervation. Twelve weeks after surgery, all rabbits were sacrificed. Range of motion, macroscopic evaluation of cartilage using modified Outerbridge scoring, and histopathological assessment using a modified histologic scoring system for cartilage were evaluated. RESULTS: Three rabbits died during the study. Nine cases and eight animals from the control group were included in the final evaluation. All rabbits had passive full range of motion. Mean Outerbridge score was 2.0 in the case group and 0.37 in the control group (p=0.002). There were statistically significant differences in cellularity (p=0.016), loss of matrix (p=0.004), and clustering of chondrocytes (p=0.008) between the two groups. Microscopic variables as a whole were statistically significant (p=0.001). CONCLUSIONS: Circumpatellar electrocauterization may result in cartilage destruction. So, we encourage caution in using routine electrocauterization in patients undergoing total knee arthroplasty. LEVEL OF EVIDENCE: level II.
Authors: Nicolaas C Budhiparama; Hendy Hidayat; Kiki Novito; Dwikora Novembri Utomo; Imelda Lumban-Gaol; Rob G H H Nelissen Journal: Clin Orthop Relat Res Date: 2020-09 Impact factor: 4.755