Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2024; 15(2): 180-191
Published online Feb 18, 2024. doi: 10.5312/wjo.v15.i2.180
Meta-analysis of factors influencing anterior knee pain after total knee arthroplasty
Hui Feng, Ming-Li Feng, Jing-Bo Cheng, Xiang Zhang, Hai-Cheng Tao
Hui Feng, Ming-Li Feng, Jing-Bo Cheng, Xiang Zhang, Hai-Cheng Tao, Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Author contributions: Feng H contributed to conceptualization, methodology, investigation, formal analysis, writing-original draft; Feng ML contributed to conceptualization, funding acquisition, resources, supervision, writing-review, and editing; Cheng JB contributed to data curation and writing-original draft; Tao HC contributed to visualization and investigation; Zhang X contributed to visualization and investigation.
Supported by the Capital Fund Project for Clinical Diagnosis and Treatment Technology Research and Translational Application, No. Z201100005520091; and Beijing Traditional Chinese Medicine Science and Technology Development Fund Project, No. JJ-2020-67.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming-Li Feng, MD, Chief Physician, Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing 100053, China. fengmingli6666@163.com
Received: October 25, 2023
Peer-review started: October 25, 2023
First decision: December 11, 2023
Revised: December 20, 2023
Accepted: January 22, 2024
Article in press: January 22, 2024
Published online: February 18, 2024
Abstract
BACKGROUND

Total knee arthroplasty (TKA) is a mature procedure recommended for correcting knee osteoarthritis deformity, relieving pain, and restoring normal biomechanics. Although TKA is a successful and cost-effective procedure, patient dissatisfaction is as high as 50%. Knee pain after TKA is a significant cause of patient dissatisfaction; the most common location for residual pain is the anterior region. Between 4% and 40% of patients have anterior knee pain (AKP).

AIM

To investigate the effect of various TKA procedures on postoperative AKP.

METHODS

We searched PubMed, EMBASE, and Cochrane from January 2000 to September 2022. Randomized controlled trials with one intervention in the experimental group and no corresponding intervention (or other interventions) in the control group were collected. Two researchers independently read the title and abstract of the studies, preliminarily screened the articles, and read the full text in detail according to the selection criteria. Conflicts were resolved by consultation with a third researcher. And relevant data from the included studies were extracted and analyzed using Review Manager 5.4 software.

RESULTS

There were 25 randomized controlled trials; 13 were comparative studies with or without patellar resurfacing. The meta-analysis showed no significant difference between the experimental and control groups (P = 0.61). Six studies were comparative studies of circumpatellar denervation vs non-denervation, divided into three subgroups for meta-analysis. The two-subgroup meta-analysis showed no significant difference between the experimental and the control groups (P = 0.31, P = 0.50). One subgroup meta-analysis showed a significant difference between the experimental and control groups (P = 0.001). Two studies compared fixed-bearing TKA and mobile-bearing TKA; the results meta-analysis showed no significant difference between the experimental and control groups (P = 0.630). Two studies compared lateral retinacular release vs non-release; the meta-analysis showed a significant difference between the experimental and control groups (P = 0.002); two other studies compared other factors.

CONCLUSION

Patellar resurfacing, mobile-bearing TKA, and fixed-bearing TKA do not reduce the incidence of AKP. Lateral retinacular release can reduce AKP; however, whether circumpatellar denervation can reduce AKP is controversial.

Keywords: Total knee arthroplasty, Anterior knee pain, Knee osteoarthritis, Interventions, Meta-analysis

Core Tip: In our meta-analysis, we searched PubMed, EMBASE, and Cochrane from January 2000 to September 2022, and we included only high level randomized controlled trials in order to get more accurate results. We discussed the influence of multiple factors on anterior knee pain after total knee arthroplasty, with different results from previous studies.