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Partial Denervation for Persistent Neuroma Pain After Total Knee Arthroplasty

1995; Lippincott Williams & Wilkins; Volume: &NA;; Issue: 316 Linguagem: Inglês

10.1097/00003086-199507000-00020

1528-1132

A. Lee Dellon, Michael A. Mont, KENNETH A. KRACKOW, David S. Hungerford,

Total Knee Arthroplasty Outcomes

Despite the high percentage of patients who are satisfied completely with the results of total knee arthroplasty, there is a small group who remain disabled because of persistent neuroma pain. Recently, a better understanding of the innervation of the skin and capsule around the human knee joint has provided a theoretical basis for denervation in this group of patients. Fifteen patients were identified who had persistent or worse knee pain for >6 months after total knee arthroplasty. In each patient, component loosening, misalignment, knee instability, and infection had been excluded systematically as a source of pain. Pain was evaluated preoperatively with the Knee Society Functional Score Questionnaire and a visual analog scale. To be selected for surgery, each patient must have had a reduction by 5 points on the visual analogue scale for pain after undergoing selective nerve blocks. Postoperative assessment was done by a team that did not include the surgeon who did the denervation. The technique for selective knee denervation is described in detail. All 15 patients had at least 1 of the nerves to the knee selectively denervated (45 nerves in 15 patients). All patients reported subjective improvement in the immediate postoperative period. This improvement was maintained at a mean followup of 12 months (range, 6–16 months). Selective knee denervation is indicated in the management of intractable knee pain of neuroma origin after total knee arthroplasty.