The Relationship between Incorrect Restoration of the Joint Line and Lateral Knee Pain in Patients Undergoing Total Knee Arthroplasty

Cetin Isik,Mesut Tahta,Ramazan Akmese,Uygar Dasar,Murat Bozkurt,Nurdan Cay,Derya Isik

doi:10.4236/ojra.2014.43020

Abstract

Aim: In this study, the relationship between the change in the joint line and lateral knee pain was evaluated after primary total knee arthroplasty. Material and method: Between 2005 and 2012, patients who underwent primary total knee arthroplasty were included in the study. Patients having “cruciate retaining total knee arthroplasty” and with a change of the joint line ≥8 mm and patients having “posterior stabilized total knee arthroplasty” and with a change of the joint line ≥5 mm were selected as the study group (group 1, n = 32). A total of 47 patients having similar demographic characteristics with the study group and the joint line changing below the predetermined level or remaining unchanged were included as the control group (group 2). The 2 groups were compared according to the presence of knee pain, the localization and spread of the pain, iliotibial band, tension and pain in the patellar tendon and quadriceps tendon, front knee pain during squatting, VAS pain score, OBER test positivity, Knee Society knee and function score, and general patient satisfaction. Results: There were statistically significant more lateral knee pain (p < 0.001), OBER test positivity (p < 0.001) and iliotibial band tension (p < 0.001) in group 1 compared to group 2. However, there were no statistically significant differences between the 2 groups regarding rest pain (p = 0.855), pain during squatting (p = 0.761), exertional pain (p = 0.322), pain in the patellar tendon (p = 0.643) and quadriceps tendon (p = 0.873), Knee Society knee (p = 0.954) and function (p = 0.955) scores, and general satisfaction (p = 0.968). Conclusion: In total knee prosthesis operations, distal displacement of the joint line can result in lateral knee pain and iliotibial band tension. However, considering the results of total knee arthroplasty our findings have showed that this condition has no effect on knee functions and patient satisfaction.

Highlights

Total knee arthroplasty (TKA) is one of the most successfully performed surgical procedures nowadays
Unresolved knee pain seen in approximately 20% of patients after total knee arthroplasty is a serious complication which can cause medical, social and legal problems [8]
Pandher et al presented a case with posterolateral knee pain after total knee arthroplasty

Summary

Introduction

Total knee arthroplasty (TKA) is one of the most successfully performed surgical procedures nowadays. TKA is forming an artificial joint, which the joint surfaces are covered by specially shaped metal and polyethylene. It is widely used in the treatment of excessively worn joint surfaces by osteoarthritis, trauma, age, obesity, rheumatologic disorders and previous cartilage or meniscus surgery. Too many studies have been performed about pain In these studies, many factors such as age, sex, drug use, comorbidities, physiological factors, and knee scores have been evaluated [3] [4]. As the tolerability border is different in prosthesis types including posterior cruciate ligament retaining total knee arthroplasty (CR-TKA) and posterior stabilized total knee arthroplasty (PS-TKA) types, incorrect restoration of the original joint line can cause primarily pain, instability, motion limitation, and joint stiffness [5]

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