Patients with High Chronic Postoperative Knee Pain 5 years after Total Knee Replacement Demonstrate Low-grad Inflammation, Impairment of Function and High Levels of Pain Catastrophizing

Background: Chronic pain after total knee replacement is common but remains poorly understood. Management options for patients with this condition are traditionally limited to pharmacological approaches. Objective: This article presents a case of using spinal cord stimulation in the management of chronic knee pain following total knee replacement. Design: Case report Setting: Pain management clinic Methods: A 68-year old patient presented with a 3-year history of persistent knee pain following total knee replacement. After failing to respond to medications and nerve blocks, a trial of spinal cord stimulation and subsequent permanent implantation of a spinal cord stimulator (SCS) were performed. The Oxford knee score (OKS) was used to assess her pain and functionality before and after SCS implantation. Results: The patient reported improvement in her pain and function. Her baseline OKS was 39 and fell to 26 one year post implantation of an SCS representing a reduction of pain and disability from severe to moderate. Limitations: A case report. Conclusion: Spinal cord stimulation might be an option in the management of refractory knee pain following total knee replacement. Key Words: total knee replacement, knee pain, spinal cord stimulation

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Development of a bedside tool kit for assessing sensitization in patients with chronic osteoarthritis knee pain or chronic knee pain after total knee replacement

Pain ◽

10.1097/j.pain.0000000000002335 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Juliane Sachau ◽

Jan Carl Otto ◽

Viktoria Kirchhofer ◽

Jesper Bie Larsen ◽

Lieven Nils Kennes ◽

...

Keyword(s):

Total Knee Replacement ◽

Knee Pain ◽

Knee Replacement ◽

Chronic Knee Pain ◽

Osteoarthritis Knee ◽

Total Knee

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Revision of total knee replacement (TKR) secondary to raised cobalt levels: should this be considered in the painful TKR patient?

BMJ Case Reports ◽

10.1136/bcr-2020-240674 ◽

2021 ◽

Vol 14 (7) ◽

pp. e240674

Author(s):

Fred Kenny ◽

John P Gibbons ◽

Peter Keogh ◽

John O'Byrne

Keyword(s):

Total Knee Replacement ◽

Aseptic Loosening ◽

Knee Pain ◽

Knee Replacement ◽

Comprehensive Assessment ◽

Total Knee ◽

Symptomatic Outcome ◽

Periprosthetic Fluid ◽

Multiple Samples ◽

Knee Revision

A 63-year-old woman was referred to the specialised knee revision clinic with ongoing knee pain after total knee replacement. She incidentally had cobalt and chromium levels measured. These were seen to be elevated. Comprehensive assessment and investigation did not identify any other source of cobalt or chromium. Aseptic loosening of the knee was diagnosed, and the knee was revised. At the time of surgery, the tissue was seen to be darkened consistent with metallosis. Multiple samples excluded infection on extended cultures. Aspirated fluid showed that periprosthetic fluid had elevated cobalt levels. The knee was successfully revised with good symptomatic outcome and significantly, over the course of several months post-revision, the cobalt and chromium levels returned to normal.

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