scholarly journals Literature review of the causes of pain following total knee replacement surgery: prosthesis, inflammation and arthrofibrosis

2020 ◽  
Vol 5 (9) ◽  
pp. 534-543
Author(s):  
Cheuk Yin Li ◽  
Kenneth Jordan Ng Cheong Chung ◽  
Omar M. E. Ali ◽  
Nicholas D. H. Chung ◽  
Cheuk Heng Li
Keyword(s):  
Risk Factors ◽  
Literature Review ◽  
Knee Pain ◽  
Knee Replacement ◽  
Polyethylene Wear ◽  
Publication Date ◽  
Ageing Population ◽  
Replacement Surgery ◽  
Patellar Maltracking ◽  
Total Knee

Adverse knee pain occurs in 10–34% of all total knee replacements (TKR), and 20% of TKR patients experience more pain post-operatively than pre-operatively. Knee pain is amongst the top five reasons for knee replacement revision in the United Kingdom. The number of TKRs is predicted to continue increasing due to the ageing population. A narrative literature review was performed on the different causes of pain following TKR. A database search on Scopus, PubMed, and Google Scholar was conducted to look for articles related to TKR, pain, and cause. Articles were selected based on relevance, publication date, quality of research and validation. Relevant sections were added to the review. One hundred and fourteen articles were identified and potential causes of TKR pain included: arthrofibrosis, aseptic loosening, avascular necrosis, central sensitization, component malpositioning, infection, instability, nerve damage, overstuffing, patellar maltracking, polyethylene wear, psychological factors and unresurfaced patella. It is important to tailor our approach to address the individual causes of pain. Certain controllable risk factors can be managed pre-operatively to minimize post-operative pain. Risk factors help to predict adverse pain outcomes and identify specific causes. There are multiple causes of pain following TKR. Some factors will require further extensive studies, and as pain is a commonly attributed reason for TKR revision, its underlying aetiologies should be explored. Understanding these factors helps to develop effective methods for diagnosis, prevention and management of TKR pain, which help to improve patient outcomes. Cite this article: EFORT Open Rev 2020;5:534-543. DOI: 10.1302/2058-5241.5.200031

scholarly journals Microfragmented Adipose Tissue Injection (MFAT) May Be a Solution to the Rationing of Total Knee Replacement: A Prospective, Gender-Bias Mitigated, Reproducible Analysis at Two Years

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Nima Heidari ◽  
Tiffanie-Marie Borg ◽  
Stefano Olgiati ◽  
Mark Slevin ◽  
Alessandro Danovi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Adipose Tissue ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Oxford Knee Score ◽  
Ageing Population ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Total Knee

Background. Knee osteoarthritis (KOA) is a significant cause of disability in a globally ageing population. Knee replacement surgery has been shown to improve function and quality of life. Access to this intervention can be limited for a number of reasons including rationing of care, lack of healthcare provision in austere environments, and more recently, due to the cessation of elective orthopaedic care as a result of the COVID pandemic. Referral for knee replacement surgery is often guided by the patient’s Oxford Knee Score (OKS). Recent therapies including treatment with microfragmented adipose tissue (MFAT) have emerged as alternatives to relieve pain and improve function in such patients. Method. We identified all patients with KOA Kellgren-Lawrence grade 3 and 4 in our dataset of patients treated with a single injection of MFAT and applied published OKS thresholds for referral for TKR to separate them into 3 cohorts according to their functional impairment. 220 patients (95 females, 125 males) with KOA were given one MFAT injection. The function (OKS) and quality of life (EuroQol-5) prior to and 24 months after therapy were compared. Results. MFAT injection provided a statistically significant improvement in the quality of life (EQ-5D) at 24 months in patients with a baseline OKS of 39 or less ( p value: <0.001) as well as those with OKS of 27 or less who are deemed suitable for a knee replacement ( p value: <0.001). Conclusion. MFAT injection improves quality of life in patients with KOA who are deemed suitable for the knee replacement. MFAT is a low-morbidity alternative biological treatment and can delay the need for total knee replacement in suitable patients.

scholarly journals Anatomy of the Infrapatellar Branch in Relation to Skin Incisions and as the Basis to Treat Neuropathic Pain by Percutaneous Cryodenervation

2014 ◽  
Vol 3;17 (3;5) ◽  
pp. E339-E348 ◽  
Author(s):  
Thomas Ackmann
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Skin Incision ◽  
Knee Surgery ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Infrapatellar Branch ◽  
Total Knee

Background: Neuropathic knee pain, particularly of the infrapatellar branch, is an important complication of knee replacement surgery, with an incidence as high as 70%. The increasing number of elderly patients requiring knee surgery, including total knee arthroplasty (TKA), has contributed to an increase in the number of patients with this pathology. Treatment includes neurectomy, infiltration therapy, and cryodenervation. Percutaneous cryodenervation of the infrapatellar branch is a promising option. Objective: To provide the necessary anatomical analysis to optimize percutaneous cryodenervation of the infrapatellar branch by defining sections of the unbranched ramus infrapatellaris to demonstrate the risk of nerve injury through 3 different skin incisions typically used during TKA. Study Design: Anatomical study. Methods: Cadavers were used for assessment. Exclusion criteria were scars from knee surgery, deep wounds, and a flexion angle of no more than 90°. We compared 3 frequently used skin incisions with the course of the infrapatellar branch and identified sections of the unbranched nerves that were suitable for percutaneous cryodenervation. Results: In total, 18 formalin-fixed cadavers (mean age, 78.9 years) contributed 30 knees (15 pairs) for dissection. We identified the following 4 anatomical variations of the ramus infrapatellaris in relation to the sartorius muscle: anterior, posterior, penetrating, and pes anserinus types. Sections were then found to treat the nerve branch types. The nerve sections were localized using the medial pole of the patella as a palpable landmark and varied in length between 15 mm and 40 mm. The medial parapatellar skin incision showed the highest risk of lesions to the infrapatellar branch (53.3%) followed by the midline skin incision (46.7%) and the lateral parapatellar skin incision (30.0%). Limitations: This was an observational study, performed using a limited number of cadavers. This therefore precluded generalization and statistical analysis. Significantly more female (13) cadavers were examined compared to male (5). Further studies in human populations, and with larger samples, are necessary to confirm these results. Conclusion: Based on our findings, the surgeon can localize the unbranched main nerve. Compared with the current practice, our approach should allow for a lower impact on tissues and should facilitate complete pain relief through a single cryodenervation. Furthermore, we propose that the lateral parapatellar skin incision is an acceptable alternative surgical approach in knee replacement surgery because it is associated with the lowest risk of damage to the infrapatellar branch. Key words: Percutaneous cryodenervation, infrapatellar branch, neuropathic knee pain, knee surgery, skin incisions knee surgery, total knee arthroplasty

Iliotibial band enthesopathy: an unusual cause of lateral knee pain post total knee replacement

2021 ◽  
Author(s):  
G. Hegde ◽  
A. Subramanian ◽  
C. Azzopardi ◽  
A. Patel ◽  
S. L. James ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Pain ◽  
Knee Replacement ◽  
Iliotibial Band ◽  
Total Knee ◽  
Lateral Knee Pain

scholarly journals Self-Reported Knee Instability Before and After Total Knee Replacement Surgery

2016 ◽  
Vol 68 (4) ◽  
pp. 463-471 ◽  
Author(s):  
Genevieve Fleeton ◽  
Alison R. Harmer ◽  
Lillias Nairn ◽  
Jack Crosbie ◽  
Lyn March ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Instability ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Total Knee Replacement Surgery ◽  
Before And After ◽  
Total Knee

scholarly journals Consistency of Knee Pain and Risk of Knee Replacement: The Multicenter Osteoarthritis Study

2011 ◽  
Vol 38 (7) ◽  
pp. 1390-1395 ◽  
Author(s):  
BARTON L. WISE ◽  
DAVID T. FELSON ◽  
MARGARET CLANCY ◽  
JINGBO NIU ◽  
TUHINA NEOGI ◽  
...  
Keyword(s):  
Knee Pain ◽  
Knee Replacement ◽  
Clinic Visit ◽  
Pain Severity ◽  
Relative Risks ◽  
Increased Risk ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Risk Of Disease ◽  
Total Knee

Objective.To examine whether the consistency or persistence of knee pain, in addition to its severity, predicts incident total knee replacement (TKR).Methods.The Multicenter Osteoarthritis Study (MOST) is a longitudinal study of persons aged 50 to 79 years with symptomatic knee osteoarthritis or at high risk of disease. Subjects were queried about the presence of knee pain on most days of the previous 30 days (i.e., frequent knee pain; FKP) at 2 timepoints: a telephone screen followed by a clinic visit (median separation 4 weeks). We defined a knee as having “consistent pain” if the subject answered positively to the FKP question at both timepoints, “inconsistent pain” if FKP was positive at only one timepoint, or as “no FKP” if negative at both. We examined the association between consistent FKP and risk of TKR using multiple binomial regression with generalized estimating equations.Results.In 3026 persons (mean age 63 yrs, mean body mass index 30.4), 2979 knees (50%) had no FKP at baseline, 1279 knees (21.5%) had inconsistent FKP, and 1696 knees (28.5%) had consistent FKP. Risk of TKR over 30 months was 0.8%, 2.6%, and 8.8% for knees with no, inconsistent, and consistent FKP, respectively. Relative risks of TKR over 30 months were 1.2 (95% CI 0.6–2.3) and 2.3 (95% CI 1.2–4.4) for knees with inconsistent and consistent FKP, compared with those without FKP. This association was consistent across each level of pain severity on the Western Ontario and McMaster Universities Osteoarthritis Index.Conclusion.Consistency of frequent knee pain is associated with an increased risk of TKR independently of knee pain severity.

scholarly journals Comparison of 2 Analgesia Modalities in Total Knee Replacement Surgery: Is There an Effect on Knee Function Rehabilitation?

2017 ◽  
Vol 23 ◽  
pp. 3019-3025 ◽  
Author(s):  
Janis Zinkus ◽  
Lina Mockutė ◽  
Arūnas Gelmanas ◽  
Ramūnas Tamošiūnas ◽  
Arūnas Vertelis ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Function ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Total Knee Replacement Surgery ◽  
Total Knee
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