Abstract
Objective
The purpose of this technical report is to review the sonographic spectrum of abnormalities accounting for peri-articular pain after knee replacement surgery, as well as to demonstrate the clinical utility of ultrasound in the diagnosis and treatment of this subset of patients.
Materials and methods
Utilizing an imaging report database, we performed a search for ultrasound examinations performed by a single radiologist for knee pain after knee arthroplasty at our institution over a 10-year period. The search yielded 63 patients, whom we have categorized by causative pathology, with representative diagnostic and procedural ultrasound images selected for inclusion.
Results
Our search yielded multiple causes of peri-articular knee pain after arthroplasty, including medial and lateral retinacular impingement and scarring, iliotibial band or conjoined tendon irritation, popliteus tendon impingement, medial collateral ligament impingement, pes anserine bursitis, and scarring of Hoffa’s fat pad.
Conclusion
While knee arthroplasty is an often-successful procedure, it can be complicated by post-operative peri-articular knee pain. Ultrasound provides a valuable tool for the diagnosis of painful peri-articular knee pathology, as it allows for both static and dynamic evaluation, as well as direct correlation with patient symptoms, and is not confounded by the metal components. In addition to its diagnostic utility, ultrasound can also guide diagnostic and/or therapeutic injections of anesthetic and corticosteroid. Given these advantages, ultrasound is an important tool in managing the painful post-arthroplasty knee.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Singh JA, Yu S, Chen L, Cleveland JD. Rates of total joint replacement in the United States: future projections to 2020–2040 Using the National Inpatient Sample. J Rheumatol. 2019;46(9):1134–40.
Choi YJ, Ra HJ. Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res. 2016;28(1):1–15.
Djahani O, Rainer S, Pietsch M, Hofmann S. Systematic analysis of painful total knee prosthesis, a diagnostic algorithm. Arch Bone Jt Surg. 2013;1(2):48–52.
Manning BT, Lewis N, Tzeng TH, Saleh JK, Potty AGR, Dennis DA, et al. Diagnosis and management of extra-articular causes of pain after total knee arthroplasty. Instr Course Lect. 2015;64:381–8.
Geannette C, Sahr M, Mayman D, Miller TT. Ultrasound diagnosis of osteophytic impingement of the popliteus tendon after total knee replacement. J Ultrasound Med Off J Am Inst Ultrasound Med. 2018;37(9):2279–83.
Gudena R, Pilambaraei MA, Werle J, Shrive NG, Frank CB. A safe overhang limit for unicompartmental knee arthroplasties based on medial collateral ligament strains: an in vitro study. J Arthroplasty. 2013;28(2):227–33.
Ross JA, Greenwood AC, Sasser P, Jiranek WA. Periarticular injections in knee and hip arthroplasty: where and what to inject. J Arthroplasty. 2017;32(9S):S77-80.
Kamudin NAF, Rani RA, Yahaya NHM. Pes anserine syndrome in post knee arthroplasty. A rare case report. J Clin Orthop Trauma. 2020;11(1):171–4.
Ariff MAM, Ros MIAC, Yahaya NHM. Painful pes anserine bursitis following total knee replacement surgery: two cases. Sultan Qaboos Univ Med J. 2018;18(1):e97–9.
Dragoo JL, Johnson C, McConnell J. Evaluation and treatment of disorders of the infrapatellar fat pad. Sports Med Auckl NZ. 2012;42(1):51–67.
Takagi K, Inui H, Taketomi S, Yamagami R, Kono K, Nakazato K, et al. Iliotibial band friction syndrome after knee arthroplasty. Knee. 2020;27(1):263–73.
Hegde G, Subramanian A, Azzopardi C, Patel A, James SL, Botchu R. Iliotibial band enthesopathy: an unusual cause of lateral knee pain post total knee replacement. J Ultrasound. 2022;25(1):83–7.
Bonnin MP, de Kok A, Verstraete M, Van Hoof T, Van Der Straten C, Saffarini M, et al. Popliteus impingement after TKA may occur with well-sized prostheses. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2017;25(6):1720–30.
Kazakin A, Nandi S, Bono J. Diagnosis and treatment of intraoperative popliteus tendon impingement. J Knee Surg. 2014;27(06):485–8.
Pandher DS, Boparai RS, Kapila R. Biceps tendinitis as a cause of acute painful knee after total knee arthroplasty. J Arthroplasty. 2009;24(8):1292.e15-18.
Chaiyakit P, Meknavin S, Pakawattana V. Results of peri-articular steroid injection in the treatment of chronic extra-articular pain after total knee arthroplasty. J Med Assoc Thail Chotmaihet Thangphaet. 2012;95(Suppl 10):S48-52.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Jardon, M., Miller, T.T. Diagnostic ultrasound and ultrasound-guided injections for peri-articular pain after knee replacement. Skeletal Radiol 52, 1023–1031 (2023). https://doi.org/10.1007/s00256-022-04189-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-022-04189-0