Abstract
Background: While total knee arthroplasty (TKA) is a reliable treatment for advanced knee arthritis, up to 19% of patients after TKA remain dissatisfied, especially with residual pain. A less known source of medial knee pain following TKA is infrapatellar saphenous neuroma. Ultrasound-guided local treatment with hydrodissection and corticosteroid injection is an effective short-term solution. Our primary aim was to evaluate the durability of local treatment by comparing numeric pain scores for medial knee pain after TKA at pretreatment, one month following treatment, and midterm follow-up. A secondary aim was to identify associations of patient characteristics with degree of change in numeric pain score. Methods: Retrospective chart review was performed to identify patients who had symptomatic infrapatellar saphenous neuroma following TKA and were treated with ultrasound-guided local treatment by hydrodissection and corticosteroid injection between January 1, 2012, and January 1, 2016. Those with follow-up less than three years were excluded. Patients who were unable to return for midterm follow-up were called. Numeric pain scores for the medial knee were recorded. Patient demographics, medical history, revision TKA status, number of prior knee surgeries, narcotic use, psychiatric disorders, and current tobacco use were also collected.Results: Of 32 identified patients, 29 (7 men, 22 women, median age 65.9 years) elected to participate in this study with a mean (SD) follow-up of 4.6 (0.8) years. The median (range) pretreatment pain score was 9 (5-10). After local treatment, the median (range) numeric pain score was significantly lower at both one-month and midterm follow-up (5; P<0.001). The initial response to treatment was durable given that the difference between one-month and midterm follow-up scores was not significant (P=0.47). Advanced age was associated with less overall pain relief from pretreatment to midterm follow-up, while female sex, history of fibromyalgia, and TKA revision prior to treatment were associated with worsening pain from one-month to midterm follow-up (P<0.05). Conclusions: Patients who underwent ultrasound-guided local treatment with hydrodissection and corticosteroid injection for painful postoperative infrapatellar saphenous neuroma following TKA experienced significant numeric pain score reduction. Pain relief remained consistent from 1onemonth to midterm follow-up. Level of Evidence: Level IV, Case Series
Highlights
Total knee arthroplasty (TKA) is a reliable surgical option for patients with tricompartmental knee arthritis for whom nonsurgical treatment has failed
Selective surgical neuroma excision is a possible solution with 84% of patients reporting goodexcellent outcomes, nonsurgical management with ultrasound-guided local treatment with hydrodissection combined with corticosteroid injection has been shown to be an effective short-term solution [2,3]
In this retrospective chart review approved by the Institutional Review Board, we identified patients diagnosed with symptomatic infrapatellar saphenous neuromas following total knee arthroplasty (TKA) who were treated with ultrasound-guided hydrodissection and corticosteroid injection between January 1, 2012, and January 1, 2016
Summary
Total knee arthroplasty (TKA) is a reliable surgical option for patients with tricompartmental knee arthritis for whom nonsurgical treatment has failed. A lesser known but previously described source of medial knee pain following TKA is infrapatellar saphenous neuroma [2,3]. This nerve is susceptible to injury during the TKA procedure from the anteromedial arthrotomy, retractor placement, and less commonly, the tourniquet [2]. Selective surgical neuroma excision is a possible solution with 84% of patients reporting goodexcellent outcomes, nonsurgical management with ultrasound-guided local treatment with hydrodissection combined with corticosteroid injection has been shown to be an effective short-term solution [2,3]. A less known source of medial knee pain following TKA is infrapatellar saphenous neuroma. A secondary aim was to identify associations of patient characteristics with degree of change in numeric pain score
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