A Randomised Controlled Prospective Study of the Role of Patellar Denervation in Total Knee Arthroplasty Surgery without Patellar Resurfacing

Background: Anterior knee pain (AKP) remains a common cause of dissatisfaction after total knee arthroplasty (TKA). Circumpatellar denervation using electrocautery has been proposed to reduce postoperative pain by ablating nociceptive fibers in peripatellar tissues. Aim: To evaluate the effect of intraoperative patellar denervation by electrocautery on postoperative anterior knee pain and functional outcomes in patients undergoing primary TKA for osteoarthritis. Methods: This prospective randomized comparative study was conducted at BGS Global Hospital, Bangalore, between July 2019 and May 2021. Seventy patients aged 45–80 years with advanced primary knee osteoarthritis undergoing TKA were randomized into two groups: electrocautery (n=35) and control (n=35). All patients underwent standard TKA. The intervention group received circumpatellar electrocautery using monopolar diathermy. Outcomes were assessed preoperatively and at 1, 3, 6, and 12 months using the Visual Analogue Scale (VAS), Insall Knee Score (KSS), Patellar Score (PS), and range of motion (ROM). Statistical analysis was performed using repeated-measures ANOVA. Results: Both groups showed significant postoperative improvement. However, the electrocautery group demonstrated significantly lower VAS scores at all follow-ups (12-month mean: 0.03 vs 0.49; p<0.001). Functional outcomes were superior in the intervention group, with higher KSS (94.63 vs 89.74) and PS (27.23 vs 22.26) at one year (p<0.001). ROM improved in both groups without statistically significant intergroup difference. Conclusion: Circumpatellar patellar denervation during TKA significantly reduces anterior knee pain and improves functional outcomes. The technique is simple and safe, though larger long-term studies are recommended.