scholarly journals Genicular Nerve Radiofrequency Ablation and Dual Subsartorial Block for Chronic Knee Pain Post Total Knee Replacement: A Case Report

2022 ◽  
Vol 2 (2) ◽  
pp. 253-257
Author(s):  
Aidyl Fitrisyah ◽  
Stevanus Eliansyah Handrawan ◽  
Nurlaili Maya Ramadhanty
Keyword(s):  
Chronic Pain ◽  
Radiofrequency Ablation ◽  
Total Knee Replacement ◽  
Knee Pain ◽  
Knee Replacement ◽  
Rating Scale ◽  
Womac Score ◽  
Assessment Tools ◽  
Chronic Knee Pain ◽  
Total Knee

Introduction. Chronic pain defines as pain persisting for three months or longer, chronic post-surgical pain can affect all dimensions of health-related quality of life, and is associated with functional limitations. treatment of chronic pain after total knee replacement is challenging, and evaluation of combined treatments and individually targeted treatments matched to patient characteristic. Genicular nerve block radiofrequency ablation is a safe and effective therapeutic procedure for pain associated with chronic pain due to knee osteoarthritis, and the evolution of newer regional analgesia techniques aids in reducing postoperative pain Dual Subsartorial Block (DSB) as a procedure specific, post total knee replacemet. historically there has been a reliance on using a pain-spesific assessment tools Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Case Presentation. A 55-year old woman admitted she had pain on bilateral knee, the knee pain had affected her daily living, she was diagnosed with chronic knee pain post TKR because of osteoarthritis genu bilateral, the patient was planning genicular nerve radiofrequency ablation and dual subsartorial block, from the examination we found that numeric rating scale was 6 (moderate pain) with WOMAC score 76, before the procedure the patients are examined through radiology for any deformity in the knee. The genicular nerve radiofrequency ablation under ultrasound guidance on bonylandmark, resulting anesthesia of the anterior compartment of the knee, and dual subsartorial block that cover almost all the innervations of pain generating component of the anterior and posterior knee joint involved in TKR surgery. After the procedure we reevaluated the pain score using NRS was 2 (mild pain), and with WOMAC Score 19. Conclusion. Treatment of chronic pain post total knee replacemet was challenging, targeted treatment may ameliorate the pain and prevent long term disability.  

scholarly journals A Systematic Review of the Effectiveness of Rehabilitation Therapy to Treat People with Chronic Knee Pain Following A Total Knee Replacement.

2020 ◽  
Author(s):  
Nathan Adam Johns ◽  
Justine Naylor ◽  
Brinda Thirugnanam ◽  
Dean Mckenzie ◽  
Bernadette Brady ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Chronic Pain ◽  
Total Knee Replacement ◽  
Knee Pain ◽  
Knee Replacement ◽  
Chronic Knee Pain ◽  
Total Knee ◽  
Full Text Screening

Abstract Background:Chronic knee pain after a total knee replacement has been estimated to affect 10 to 30% of patients and is related to dissatisfaction with surgery, reduced function and reduced quality of life. Rehabilitation is often prescribed in the subacute period post-operatively, but it may offer benefit to the increasing numbers of patients with chronic pain after their knee replacement. The aim of this systematic review is to evaluate the effectiveness of rehabilitation to improve pain, function and quality of life in people with chronic knee pain persisting for more than 3 months following a total knee replacement.Methods: The systematic review was conducted following PRISMA guidelines with a search of the online databases Ovid Medline, Embase via Ovid, CINAHL Plus, PsycINFO, Ovid Emcare and Proquest from their earliest date to July 12, 2020. The search criteria included English language randomised controlled trials of rehabilitation strategies in any setting to treat people with chronic knee pain, defined as knee pain persisting for more than 3 months, following a total knee replacement. Rehabilitation programs included exercise therapy, patient education, cognitive and mind-body strategies and self-management and excluded medication trials, procedural techniques and complementary therapies. Results:There were 254 abstracts screened for eligibility with 13 remaining for full-text screening. Following full-text screening, there were no studies that met the eligibility criteria for evaluating rehabilitation therapy to treat chronic knee pain persisting for more than 3 months following a total knee replacement.Conclusion:Despite the high volume of knee replacement surgery and the high incidence of moderate to severe chronic pain ensuing, there is currently no evidence available that rehabilitation commencing three months after surgery can effectively treat chronic pain and disability following a total knee replacement.

scholarly journals Spinal Cord Stimulation for the Treatment of Chronic Knee Pain Following Total Knee Replacement

2010 ◽  
Vol 3;13 (3;5) ◽  
pp. 251-256
Author(s):  
Thomas T. Simopoulos
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Total Knee Replacement ◽  
Knee Pain ◽  
Knee Replacement ◽  
Spinal Cord Stimulation ◽  
Management Options ◽  
Chronic Knee Pain ◽  
Patient Reported ◽  
Total Knee

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

scholarly journals 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 ◽  
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

scholarly journals Comparison of two different models of rehabilitation programs following total knee replacement operations

2020 ◽  
Vol 47 (1) ◽  
Author(s):  
Rabab S. Zaghlol ◽  
Sahar S. Khalil ◽  
Ahmed M. Attia ◽  
Ghada A. Dawa
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
High Intensity ◽  
Rating Scale ◽  
Rehabilitation Program ◽  
Low Intensity ◽  
Rehabilitation Programs ◽  
Patient Reported ◽  
Total Knee ◽  
Functional Gain

Abstract Background Total knee replacement operation (TKR) is the treatment of choice in severe knee osteoarthritis (OA). Rehabilitation post-TKR is still not well studied. The aim of this study was to compare between the high-intensity (HI) rehabilitation program and the low-intensity (LI) rehabilitation program following TKR. Results At 1 month following the TKR operations, significant improvements were found in the first group compared to the second group in all the measured parameters except for the knee range of motion (ROM). At 3 and 12 months follow-up periods, there were statistically significant differences between both groups in all the evaluated parameters except for the numeric pain rating scale and the knee ROM. Conclusions Both high-intensity and low-intensity rehabilitation programs are effective; however, HI program had superior functional gain and patient-reported outcomes compared to the LI program. Moreover, HI group has a long-term functional gain.

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

Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up

2019 ◽  
Vol 44 (6) ◽  
pp. 646-651 ◽  
Author(s):  
David Walega ◽  
Zachary McCormick ◽  
David Manning ◽  
Michael Avram
Keyword(s):  
Radiofrequency Ablation ◽  
Postoperative Pain ◽  
Knee Pain ◽  
Controlled Trial ◽  
Postoperative Pain Management ◽  
Opioid Use ◽  
Management Regime ◽  
Chronic Knee Pain ◽  
Pain Outcomes ◽  
Total Knee

Background and objectivesRefractory chronic knee pain from osteoarthritis (OA) is commonly treated with total knee arthroplasty (TKA). TKA can be associated with severe postoperative pain and persistent postsurgical knee pain. Poorly controlled postoperative pain can negatively effect functional outcomes following TKA, and effective opioid-sparing analgesia is key to the ideal recovery. Genicular nerve radiofrequency ablation (GN-RFA) has been shown in several trials to be clinically effective in patients with severe refractory knee pain from OA. We aimed to assess if preoperative GN-RFA would improve postoperative pain outcomes following TKA.MethodsThis was a sham-control prospective clinical trial in which blinded participants were randomized to image-guided GN-RFA or a simulated sham procedure 2-6 weeks prior to elective TKA. Outcomes were assessed at 48 hours and 1, 3 and 6 months following TKA.ResultsSeventy participants enrolled in this study. As compared with sham controls, GN-RFA had no treatment effect on postoperative opioid consumption, pain or functional measures at any time point.ConclusionsCooled RFA of the superior lateral, superior medial and inferomedial genicular nerves, when performed 2–6 weeks prior to elective TKA as part of a multimodal postoperative pain management regime, had no measurable effect on postoperative opioid use, analgesia use or function in the 48 hours following surgery. In addition, we found no longer term effect on outcome measures 1, 3 and 6 months after TKA.Trial registration numberNCT02746874.

scholarly journals Genicular Nerve Radiofrequency Ablation for Chronic Knee Pain Using a Three-Tined Electrode: A Technical Description and Case Series

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3344-3349
Author(s):  
Edvin Koshi ◽  
Cole W Cheney ◽  
Beau P Sperry ◽  
Aaron Conger ◽  
Zachary L McCormick
Keyword(s):  
Radiofrequency Ablation ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Vastus Medialis ◽  
The Novel ◽  
Chronic Knee Pain ◽  
Numeric Rating

Abstract Background Genicular nerve radiofrequency ablation (RFA) for the treatment of chronic knee pain has traditionally targeted the superomedial, superolateral, and inferomedial genicular nerves. However, recent cadaveric studies of knee neuroanatomy demonstrate varied locations of these specific nerves as well as additional articular nerves. This work suggests that traditional genicular nerve RFA lesion locations may be inadequate. Objective 1) To describe a novel protocol utilizing a three-tined RFA electrode to target the superomedial (SMGN), superolateral (SLGN), and inferomedial genicular nerves (IMGN), as well as the terminal articular branches of the nerves to the vastus medialis (NVM), intermedius (NVI), and lateralis (NVL). 2) To assess the ability of this technique to reduce chronic knee pain. Methods Case series of consecutive patients with six or more months of refractory knee pain who underwent genicular nerve RFA according to the novel protocol described. Seven discrete RFA lesions were placed to target the SMGN, NVM, NVI, NVL, SLGN, and IGMN. Results Eleven patients underwent RFA, nine with knee osteoarthritis and two postarthroplasty. At one month, 91% (95% CI = 59–100%), 82% (95% CI = 48–98%), and 9% (95% CI = 2–41%), of patients reported ≥50%, ≥80%, and 100% improvement in knee pain on the numeric rating scale, respectively. These results were sustained at six months. There were no complications. Discussion/Conclusions These preliminary data suggest the feasibility and possible effectiveness of genicular nerve RFA using the described novel protocol including a three-tined electrode. Larger-scale studies with comparative groups are warranted.

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