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Selective Denervation for Persistant Pain After Total Knee Arthroplasty: A Report of 37 Cases
Shao-Min Shi, MD and James T. Ninomiya, MD
Medical College of Wisconsin, Milwaukee, WI
Introduction: Disabling pain from cutaneous neuroma occurs in up to ten percent of patients following total knee arthroplasty. This is a therapeutic challenge that compromises the success rate of total knee arthroplasty. Dellon first reported selective denervation for the chronic knee neuroma pain in 1995, with only rare reports since. We present a case series of patients who underwent selective denervation for persistent postoperative knee neuroma pain and obtained an excellent outcome. Materials and Methods: Between 2011 and 2013, 35 patients with persistent diagnosed neuroma pain after total knee arthroplasty underwent selective denervation. Diagnosis required 50% or greater pain relief after selective nerve local blocks. There were 25 women and 10 men in the study with a mean age of 58 years (range 29-81). All patients had had a nonoperative desensitization therapy prior to their neuroma surgery. After the failure of previous surgical attempts, the patients were treated by selective denervation procedure with multiple sensory nerve neuroma resections by a single surgeon. Average follow-up duration was 5 months (range1 to17 months). Patients were evaluated by the mean Knee Society Score as well as the subjective pain scale ranging from 0-10. Results: 24/35 (69%) rated their outcome as excellent, 8/35(22%) as good and 2/35 (6%) judged the outcome as fair and 1/35 (3%) no change. The mean pain score was significant (p<0.0001) reduced from 9.4 to 1.1. The Knee Society Score increased from a mean of 44.3 to 89.6 points (P<0.0001). There were 2 complications of superficial skin hyperemia around the incision related to topical dressings that resolved with wound care. There were no deep infections and no recurrence of pain. Conclusions: Selective knee denervation provides an effective and reliable option for the management of intractable knee pain of neuroma origin after total knee arthroplasty. If diagnostic selective nerve blocks result in pain reduction of 50% or more, patients can expect good to excellent pain relief from the selective denervation
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