Does circumpatellar electrocautery improve the outcome after total knee replacement?: a prospective, randomised, blinded controlled trial.

The incidence of anterior knee pain following total knee replacement (TKR) is reported to be as high as 49%. The source of the pain is poorly understood but the soft tissues around the patella have been implicated. In theory circumferential electrocautery denervates the patella thereby reducing efferent pain signals. However, there is mixed evidence that this practice translates into improved outcomes. We aimed to investigate the clinical effect of intra-operative circumpatellar electrocautery in patients undergoing TKR using the LCS mobile bearing or Kinemax fixed bearing TKR. A total of 200 patients were randomised to receive either circumpatellar electrocautery (diathermy) or not (control). Patients were assessed by visual analogue scale (VAS) for anterior knee pain and Oxford knee score (OKS) pre-operatively and three months, six months and one year post-operatively. Patients and assessors were blinded. There were 91 patients in the diathermy group and 94 in the control. The mean VAS improvement at one year was 3.9 in both groups (control; -10 to 6, diathermy; -9 to 8, p < 0.001 in both cases, paired, two-tailed t-test). There was no significant difference in VAS between the groups at any other time. The mean OKS improvement was 17.7 points (0 to 34) in the intervention group and 16.6 (0 to 42) points in the control (p = 0.36). There was no significant difference between the two groups in OKS at any other time. We found no relevant effect of patellar electrocautery on either VAS anterior knee pain or OKS for patients undergoing LCS and Kinemax TKR.

Glutamate receptor subunits associated with rat sympathetic preganglionic neurons.

The purpose of this study was to determine what subunits of the glutamate (alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA)) receptor are expressed by sympathetic preganglionic neurons in the spinal cord of adult rats. Preganglionic neurons were retrogradely labelled with Fluorogold, double-labelled with choline acetyltransferase immunofluorescence, and examined with confocal microscopy for evidence of immunoreactivity for GluR1, GluR2, GluR2/3 and GluR4 subunits. Quantitative analysis revealed that 92, 63 and 85% of preganglionic cells in the T8 segment express GluR1, GluR2 and GluR2/3 subunits, respectively. Cells were not immunoreactive for the GluR4 subunit. This evidence is consistent with the idea that most sympathetic preganglionic neurons form heteromeric AMPA receptors. Cells with GluR2 subunits will assemble receptors which are impermeable to calcium ions and may be resistant to excitotoxic cell death.