Complications - OtherSelective Denervation for Persistent Knee Pain After Total Knee Arthroplasty: A Report of 50 Cases
Section snippets
Materials and Methods
This case series includes 50 patients who underwent selective denervation for persistent neuroma pain that developed after TKA. The index procedure TKAs were performed at 20 different institutions (19 outside institutions and the author's institution). The selective denervation procedures were performed at the author's institution, a tertiary referral center, between October 2011 and September 2014.
Our cohort included 50 patients, 37 women and 13 men, with a mean age of 63 years (range, 30-83
Results
The majority of patients reported satisfaction with their outcome. Thirty-two patients (64%) rated their outcome as excellent, 10 (20%) as good, 3 (6%) rated the outcome as fair, and 2 (4%) no change. The mean follow-up duration was 24 months (range, 16-38 months). The mean VAS pain score was reduced from 9.4 ± 0.8 to 1.1 ± 1.6 (P ≤ .0001) (Fig. 6). The Knee Society Score increased from a mean of 45.5 ± 14.3 to 94.1 ± 8.6 points (P ≤ .0001; Fig. 7). The affected nerves requiring release are
Discussion
As in any patient with a painful joint replacement, infection needs to be the first consideration for investigation. All patients in this series had initial evaluation including blood work with C-reactive protein, sedimentation rate, and complete blood count [12]. This is a diagnosis of exclusion, so once infection, malalignment, and instability had been ruled out with appropriate testing, chronic neuroma pain, especially in the presence of a positive Tinel's sign and improvement following
Conclusions
Pain resulting from the formation of a neuroma in sensory nerves is an underreported and underappreciated source of pain following TKA. Neuroma formation should be considered a potential etiology for persistent and intractable pain following TKA with an otherwise noninfected, well-fixed, and well-aligned TKA. Our study suggests that selective denervation provides an effective and reliable option for the management of intractable knee pain of neuroma origin after TKA.
Acknowledgments
We gratefully acknowledge the assistance of Amy Peters for her contributions to data collection.
References (29)
- et al.
Causes and predictors of patient's dissatisfaction after uncomplicated total knee arthroplasty
J Arthroplasty
(2009) - et al.
Neuroma of the infrapatellar branch of the saphenous nerve a cause of reversible knee stiffness after total knee arthroplasty
J Arthroplasty
(2008) - et al.
Prospective examination of pain-related and psychological predictors of CRPS-like phenomena following total knee arthroplasty: a preliminary study
Pain
(2003) - et al.
Reflex sympathetic dystrophy as a cause of poor results after total knee arthroplasty
J Arthroplasty
(1986) - et al.
The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales
J Bone Joint Surg Br
(2007) - et al.
A case of subcutaneous neuroma presenting with intractable pain and allodynia over the anteromedial aspect of the knee
Clin J Pain
(2012) - et al.
Traumatic neuroma of the infrapatellar branch of the saphenous nerve after hamstring harvesting
J Knee Surg
(2010) - et al.
What are the rates and causes of hospital readmission after total knee arthroplasty?
Clin Orthop Relat Res
(2014) - et al.
Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients
J Bone Joint Surg Br
(2010) - et al.
Operative management of neuromatous knee pain: patient selection and outcome
Ann Plast Surg
(2001)
Selective denervation of the knee: experience, case reports, and technical notes
Am J Knee Surg
What are the factors of residual pain after uncomplicated TKA?
Knee Surg Sports Traumatol Arthrosc
Impact of psychological distress on pain and function following knee arthroplasty
J Bone Joint Surg Am
Abnormal quantitative sensory testing is associated with persistent pain one year after TKA
Clin Orthop Relat Res
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No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.09.043.