Causes of Aseptic Persistent Pain after Total Knee Arthroplasty

다국어 초록 (Multilingual Abstract)

Background: Persistent pain after total knee arthroplasty (TKA) is dissatisfying to the patient and frustrating to the surgeon. The purpose of this study is to evaluate the aseptic causes and clinical course of intractable pain following TKA.
Methods: Of the total 2,534 cases of primary TKA reviewed, 178 cases were classified as having aseptic persistent pain that was not resolved within 1 year after surgery. Except for the cases with periprosthetic fracture (56 knees), 122 cases of aseptic painful TKA were divided into two groups: intra-articular group (83 knees) and extra-articular group (39 knees).
Results: In the intra-articular group, the main reasons for pain were aseptic loosening (n = 40), polyethylene wear (n = 16), instability (n = 10), recurrent hemarthrosis (n = 5), patellar maltracking (n = 4), tendon ruptures (n = 4), and stiffness (n = 2). In the extraarticular group, 10 knees (25.6%) were found to have nerve entrapment in the spine, 6 knees (15.4%) were found to have hip osteoarthritis or femoral head avascular necrosis. The reasons for persistent knee pain in the remaining 23 knees (59.0%) still remain elusive.
Conclusions: Persistent pain after TKA originated from pathology of extra-articular origin in a considerable number of cases in this study. Therefore, it is important to perform thorough preoperative evaluations to reduce pain resulting from extra-articular causes. Furthermore, meticulous surgical procedures and optimal alignment are required to reduce pain of intra-articular origin related to implant wear, instability, and patellar maltracking.

참고문헌 (Reference)

1 조우신, "슬관절 전치환술 후 통증" 대한정형외과학회 41 (41): 129-133, 2006

2 Dalury DF, "Why are total knee arthroplasties being revised?" 28 (28): 120-121, 2013

3 Bonnin MP, "What are the factors of residual pain after uncomplicated TKA?" 19 (19): 1411-1417, 2011

4 Bae DK, "The results of revision total knee arthroplasty" 38 (38): 689-694, 2003

5 Hofmann S, "The painful knee after TKA : a diagnostic algorithm for failure analysis" 19 (19): 1442-1452, 2011

6 Kim J, "Stiffness after total knee arthroplasty : prevalence of the complication and outcomes of revision" 86 (86): 1479-1484, 2004

7 Pinto PR, "Risk factors for moderate and severe persistent pain in patients undergoing total knee and hip arthroplasty: a prospective predictive study" 8 (8): e73917-, 2013

8 Cameron HU, "Revision of total knee replacement" 24 (24): 418-420, 1981

9 Lopez-Olivo MA, "Psychosocial determinants of outcomes in knee replacement" 70 (70): 1775-1781, 2011

10 Puolakka PA, "Persistent pain following knee arthroplasty" 27 (27): 455-460, 2010

11 Merle C, "Multidisciplinary treatment in patients with persistent pain following total hip and knee arthroplasty" 29 (29): 28-32, 2014

12 Sharkey PF, "Insall Award paper: why are total knee arthroplasties failing today?" (404) : 7-13, 2002

13 Lingard EA, "Impact of psychological distress on pain and function following knee arthroplasty" 89 (89): 1161-1169, 2007

14 Bader R, "Failure analysis of total knee replacement : basics and methodological aspects of the damage analysis" 35 (35): 896-903, 2006

15 Fehring TK, "Factors influencing wear and osteolysis in press-fit condylar modular total knee replacements" (428) : 40-50, 2004

16 Mont MA, "Exploration of radiographically normal total knee replacements for unexplained pain" (331) : 216-220, 1996

17 Mandalia V, "Evaluation of patients with a painful total knee replacement" 90 (90): 265-271, 2008

18 Dennis DA, "Evaluation of painful total knee arthroplasty" 19 (19): 35-40, 2004

19 Fehring TK, "Early failures in total knee arthroplasty" (392) : 315-318, 2001

20 Quisel A, "Complex regional pain syndrome underdiagnosed" 54 (54): 524-532, 2005

21 Perkins FM, "Chronic pain as an outcome of surgery : a review of predictive factors" 93 (93): 1123-1133, 2000

22 Al-Hadithy N, "Causes of a painful total knee arthroplasty: are patients still receiving total knee arthroplasty for extrinsic pathologies?" 36 (36): 1185-1189, 2012

23 Hoshino A, "Accurate in vivo measurement of polyethylene wear in total knee arthroplasty" 17 (17): 490-496, 2002

24 Dennis DA, "A stepwise approach to revision total knee arthroplasty" 22 (22): 32-38, 2007