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Partial denervation for persistent neuroma pain after total knee arthroplasty
A L Dellon1, M A Mont, K A Krackow
1Division of Plastic Surgery, Johns Hopkins University, Baltimore, MD, USA.
Clinical Orthopaedics and Related Research
|July 1, 1995
Summary
Persistent neuroma pain after total knee arthroplasty can be treated with selective knee denervation. This procedure offers significant pain relief and functional improvement for patients with intractable knee pain.
Area of Science:
- Orthopedic Surgery
- Pain Management
- Neuroscience
Background:
- Total knee arthroplasty (TKA) provides high patient satisfaction, but a subset experience persistent neuroma pain.
- Understanding knee joint innervation supports surgical denervation for refractory pain.
- Exclusion of mechanical causes is crucial before considering denervation.
Purpose of the Study:
- To evaluate the efficacy of selective knee denervation for intractable neuroma pain following TKA.
- To assess long-term pain reduction and functional improvement after the procedure.
Main Methods:
- Fifteen patients with persistent knee pain post-TKA, with mechanical causes excluded, were selected.
- Patients required a ≥5-point reduction on the visual analog scale (VAS) after selective nerve blocks.
- Selective knee denervation was performed, targeting specific nerves identified through blocks.
- Postoperative assessment was conducted by an independent team.
Main Results:
- All 15 patients underwent selective denervation of at least one nerve (45 nerves total).
- All patients reported immediate subjective pain improvement post-surgery.
- This improvement was sustained at a mean 12-month follow-up (range, 6-16 months).
Conclusions:
- Selective knee denervation is an effective treatment for intractable neuroma pain after total knee arthroplasty.
- The procedure offers sustained pain relief and improved function in carefully selected patients.