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

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

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Is adding intra-articular steroid in total knee arthroplasty cocktail obligatory?

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190432 ◽

2019 ◽

Vol 5 (2) ◽

pp. 260

Author(s):

Sundar Suriyakumar ◽

Ganesan G. Ram ◽

Faraz Ahmed

Keyword(s):

Total Knee Arthroplasty ◽

Total Knee Replacement ◽

Knee Replacement ◽

Knee Arthroplasty ◽

Joint Infection ◽

Knee Replacement Surgery ◽

Replacement Surgery ◽

Total Knee Replacement Surgery ◽

Group I ◽

Total Knee

Background: The patients can undergo total knee replacement surgery either under general anaesthesia, combined spinal and epidural anaesthesia, nerve root block, spinal combined with intra-articular knee cocktail. There is an ongoing debate amongst Arthroplasty surgeons whether to include steroid in the cocktail or not. The aim of this study is to assess whether there is an added benefit of including steroid in the intraarticular mixture.Methods: This prospective study was conducted at Sri Ramachandra Institute of Higher education, Chennai between December 2017 to December 2018. The study was conducted in the Arthroplasty unit, Department of Orthopaedics. SRIHER ethics committee clearance was obtained prior to the start of the study. The inclusion criteria were patients who underwent total knee replacement surgery under combined spinal and intra-articular knee cocktail. Patients were divided into two groups based on the use of steroid in the intra-articular mixture. Patients were evaluated using Visual analogue scale, opioids usage as primary endpoint while any joint infection within six months of the surgery and knee society score at 1 month and 6 months as the secondary endpoint.Results: The mean visual analogue score for the 0 pod for the group I and group II were 2.3 and 2.4 respectively. There was no case of infection in both groups.Conclusions: There is no fringe benefit of adding steroid to the knee cocktail. So it is not obligatory to add steroid in intra-articular total knee arthroplasty cocktail.

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Neuroma of the Infrapatellar branch of the saphenous nerve following Total knee Arthroplasty: a case report

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2934-0 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Yongbo Xiang ◽

Zeng Li ◽

Peng Yu ◽

Zhibo Zheng ◽

Bin Feng ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Skin Incision ◽

Saphenous Nerve ◽

Pathological Examination ◽

Infrapatellar Branch ◽

Total Knee ◽

Local Anesthetic Injection ◽

Pathological Report

Abstract Background Injury to the infrapatellar branch of the saphenous nerve (IBSN) is common during total knee arthroplasty (TKA) with a standard midline skin incision. Occasionally, painful neuromas form at the transection of nerve and cause pain and limitation of the range of motion of the knee joint. Case presentation A 70-year-old woman experienced right knee pain and stiffness for 4 years after TKA. Physical assessment revealed medial tenderness; Tinel’s sign was positive. Radiographs revealed that the prosthesis was well-placed and well-fixed. She was diagnosed with arthrofibrosis and possible neuroma after TKA. She underwent right knee exploration, neurectomy, adhesiolysis and spacer exchange. The neuroma-like tissue was sent for pathological examination. The patient recovered uneventfully and at 3-month follow-up reported no recurrence of pain or stiffness. The pathological report confirmed the diagnosis of neuroma. Conclusions IBSN injury should be a concern if surgeons encounter a patient who has pain and stiffness after TKA. Tinel’s sign, local anesthetic injection, MRI and ultrasound could help the diagnosis and identify the precise location of neuroma. Surgical intervention should be performed if necessary.

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ACL status in arthroplasty patients, why not to preserve?

SICOT-J ◽

10.1051/sicotj/2017042 ◽

2018 ◽

Vol 4 ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Ahmed Abdelbadie ◽

Ahmed Ali Toreih ◽

Mohamed Ahmed Radwan

Keyword(s):

Total Knee Arthroplasty ◽

Knee Replacement ◽

Knee Arthroplasty ◽

Cruciate Ligament ◽

Knee Kinematics ◽

Cruciate Ligaments ◽

Normal Knee ◽

Replacement Surgery ◽

Total Knee ◽

Grade 3

Introduction: Only 70–85% of patients that had total knee arthroplasty (TKA) are satisfied with their knees. The need for a near to normal knee kinematics is crucial and maybe the solution to their needs. Addressing the cruciate ligaments during surgery along with the extent of arthrosis may give a solution to this problem. Material and methods: One hundred consecutive patients in whom a total knee arthroplasty was indicated and performed were prospectively documented. During the knee replacement surgery, the condition of the anterior and posterior cruciate ligaments and the degree of osteoarthritis (OA) in the medial and lateral compartments as well as in the patello-femoral joint were documented using the Outerbridge classification. The patients’ average age was 72.3 years, with the majority being female. In all patients, a total bi-compartmental knee replacement was indicated. Results: Our results showed that in 78% of all patients the anterior, and in 98% the posterior cruciate ligament was still intact. Seventy-one percent of cases suffered from grade 4 medial osteoarthritis, 19% from grade 3 and 10% from grade 2. Thirty-six of patients suffered from grade 4 lateral osteoarthritis, 36% from grade 3, 24% from grade 2 and 4% from grade 1. Grade 4 patello-femoral osteoarthritis was present in 32% of all patients, grade 3 in 60% and grade 2 in 8% of all patients. Discussion: The goal of arthroplasty is to approximate the function of a normal knee. The retention of the anterior cruciate ligament (ACL) allows for better knee, kinematics, improved proprioception, increased flexion and an overall improvement in knee function. The decreased constraint that is possible with retention of both cruciates may decrease implant stresses and improve the implant survivorship. The distribution of OA shows that the medial and patello-femoral compartments of the joint are primarily affected. This could also allow for a more conservative and patient-tailored prosthetic design.

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Hip and knee arthroplasty

InnovAiT Education and inspiration for general practice ◽

10.1177/1755738017739331 ◽

2017 ◽

Vol 11 (1) ◽

pp. 20-27

Author(s):

Dominic Marley ◽

Nomaan Sheikh ◽

John Taylor ◽

Amit Kumar

Keyword(s):

Primary Care ◽

Knee Pain ◽

Knee Replacement ◽

Knee Arthroplasty ◽

National Joint Registry ◽

Knee Replacement Surgery ◽

Joint Registry ◽

Replacement Surgery ◽

Knee Replacements ◽

Hip And Knee Arthroplasty

The incidence of hip and knee replacement surgery has risen dramatically in recent years. The latest National Joint Registry figures indicate that almost 190 000 total hip and knee replacements were performed in 2015. The aim of this article is to discuss the management of hip and knee pain in primary care, the indications for hip and knee arthroplasty and surgical considerations.

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Self-Management following Total Knee Arthroplasty: A concept to emphasize

10.53350/pjmhs2115112835 ◽

2021 ◽

Vol 15 (11) ◽

pp. 2835-2835

Author(s):

Samreen Sadiq ◽

Rabiya Noor ◽

Ashfaq Ahmed ◽

Rizwan Akram ◽

Izzat Hassan ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Replacement ◽

Knee Arthroplasty ◽

Enhanced Recovery ◽

World Health ◽

Self Management ◽

Health Service Provider ◽

Replacement Surgery ◽

Successful Recovery ◽

Total Knee

Knee Osteoarthritis (OA) is considered as one of the leading cause of disability around the world1. Total knee Arthroplasty is known to be the best treatment option available for reduction in pain and symptoms in case of failure of conservative management2. Recently enhanced recovery pathways have been followed after knee replacement surgery which includes a combination of early mobility, education of patient and care giver, nutritional and fluid support. These enhanced pathways lead to shorter hospital stay3. Due to the shortened hospital stay, the aspect of self-management by patient becomes fundamental. Post-operative self-management of patients following knee replacement is a crucial factor for successful recovery. Self-management as defined by World Health Organization is the ability of patients, care givers and community to effectively manage with the disease, either with the support of health service provider or independently. In knee replacement, self-management includes pain management, physical therapy exercises, daily self-activities and precautionary measures4.

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Assessments of infection after total knee replacement with three years follow up period

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170033 ◽

2017 ◽

Vol 3 (2) ◽

pp. 160 ◽

Cited By ~ 1

Author(s):

Suresh Rudani ◽

Abhinav Kotak

Keyword(s):

Knee Replacement ◽

Knee Arthroplasty ◽

Culture Media ◽

Medical Science ◽

Oxford Knee Score ◽

Deep Infection ◽

Knee Replacement Surgery ◽

Replacement Surgery ◽

Infected Total Knee Arthroplasty ◽

Total Knee

Background: Knee replacement surgery also known as knee arthroplasty can help relieve pain and restore function in severely diseased knee joints. The aim of the study was designed to determine the current incidence and outcome of infected total knee arthroplasty (TKA) in our unit.Methods: Present study was performed at department of orthopedics, Gujarat Adani institute of medical science, Bhuj, Kutch, Gujarat. Questionnaire was designed as per our needs and we explained the study to all the individuals who had undergone knee replacement surgery in three years. In the questioner the patient were asked whether they had any suspicion of infection in the joint or wound after the knee surgery. If there reply was found to be affirmative than next they were asked if they had any reddened wound area, any inflammation area, readmission to the hospital due to infection, pus discharge from the wound, any further debridment or resurgery was planned for their infection and whether they were asked to take antibiotics to rule out infection.Results: Infection was identified in 20 patients of the study. All the cases underwent culture media for detection of microorganisms. Staphylococcus and E. coli were identified in majority of the cases. Six patients had undergone revision of their primary TKA for deep infection; four were having a two-stage revision with no sign of residual infection at the latest review; the oxford knee score when calculated were found to be 35, 38, 45, 48 respectively.Conclusions: During this study period, infection after primary TKA was rare but devastating and invariably led to a poor outcome.

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