全膝関節術後の切開部周囲のしびれ：有病率、経過、および機能的転帰への影響
Daniel Godoy Monzon1, Patricio Telesca1, José Manuel Pascual Espinosa1
1Hospital San Rafael, Cadiz, España.
Background:
Peri-incisional numbness commonly follows total knee arthroplasty (TKA), primarily due to injury to the infrapatellar branch of the saphenous nerve. While this sensory deficit is often perceived by patients as a minor inconvenience, its effect on clinical and functional outcomes remains debated. To evaluate the prevalence, temporal evolution, and functional impact of postoperative numbness in patients undergoing primary cemented TKA. Secondary objectives included measuring the area of numbness (AON) over time and identifying the rate of persistent skin numbness (PSN).
Material And Methods:
This prospective observational study included 437 patients (267 female, 170 male; mean age 64.1 8.6 years) who underwent primary cemented TKA using a standard medial parapatellar approach. Surgery duration, tourniquet time, wound length, hospital stay, Knee Society Score (KSS), and Roles and Maudsley satisfaction scores were recorded. Sensory assessments for light touch and pinprick were conducted at 6 weeks, 3 months, 6 months, and 1 year postoperatively. AON was quantified at each time point.
Results:
At 6 weeks postoperatively, 144 patients (32.9%) reported numbness (AON: 10.1 3.6 cm; KSS: 63.8 6.1). Numbness declined over time: 97 patients (22.2%) at 3 months (AON: 8.0 2.1 cm), 54 patients (13%) at 6 months (AON: 6.5 1.6 cm), and 38 patients (8.7%) at 1 year (AON: 4.2 2.8 cm). KSS and satisfaction scores improved across follow-up assessments. At final follow-up, 67% of patients rated outcomes as "excellent," and only 11% reported fair or poor satisfaction. Persistent numbness correlated weakly with patient dissatisfaction. Poor satisfaction was linked to complications such as wound dehiscence (1.6%) and patellar tracking pain (3.6%).
Conclusions:
1. Peri-incisional numbness is common after TKA but shows significant spontaneous improvement over 12 months. 2. Persistent numbness does not significantly impact clinical or satisfaction outcomes for the majority of patients. 3. Patients should be informed preoperatively about this expected, generally minor, and self-limiting symptom.
