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Exploration of radiographically normal total knee replacements for unexplained pain
M A Mont1, F K Serna, K A Krackow
1Orthopaedic Department, The Johns Hopkins University School of Medicine, Division of Arthritis Surgery at the Good Samaritan Hospital, Baltimore, MD, USA.
Clinical Orthopaedics and Related Research
|October 1, 1996
Summary
Exploration surgery for painful total knee replacements yielded mixed results. Patients with decreased range of motion experienced better outcomes than those with pain only, especially when preserving the original prosthesis.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Severe pain after total knee replacement (TKR) can be debilitating.
- Identifying the cause of pain in TKR is often challenging.
- Surgical exploration is sometimes necessary for undiagnosed TKR pain.
Purpose of the Study:
- To evaluate the outcomes of surgical exploration for severe, undiagnosed pain after total knee replacement.
- To compare results based on preoperative range of motion and surgical findings.
Main Methods:
- Twenty-seven patients with painful TKRs underwent surgical exploration.
- Patients were subgrouped by preoperative range of motion (ROM > 80° vs. < 80°).
- Outcomes were assessed based on pain relief and functional improvement.
Main Results:
- Overall, 41% of patients had excellent or good outcomes, while 59% had fair or poor results.
- Patients with decreased preoperative ROM (< 80°) showed better outcomes (60% good/excellent) with significant ROM improvement.
- Patients with pain only and preserved ROM had poor outcomes (17% good/excellent).
- Conversion of cementless to cemented prostheses and identified surgical issues were associated with poor results.
Conclusions:
- Surgical exploration for TKR pain has a high rate of fair to poor outcomes.
- Preserving range of motion and avoiding prosthesis conversion may improve surgical success.
- Further research is needed to optimize treatment for painful TKR.