Clin Orthop Surg.  2017 Mar;9(1):50-56. 10.4055/cios.2017.9.1.50.

Causes of Aseptic Persistent Pain after Total Knee Arthroplasty

• Lim HA
• Song EK
• Seon JK
• Park KS
• Shin YJ
• Yang HY

• KMID: 2412303
• DOI: http://doi.org/10.4055/cios.2017.9.1.50

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.

Keyword

Non-infective; Chronic pain; Causes; Total knee arthroplasty

MeSH Terms

Aged
Aged, 80 and over
Arthralgia/*etiology
Arthroplasty, Replacement, Knee/*adverse effects
Female
Femur Head Necrosis/complications
Humans
Joint Instability/complications
Male
Middle Aged
Nerve Compression Syndromes/complications
Osteoarthritis, Hip/complications
Pain, Intractable/diagnostic imaging/*etiology
Pain, Postoperative/diagnostic imaging/*etiology
Patella/physiopathology
Prosthesis Failure/adverse effects
Radiography

Figure

• 

  Fig. 1 Flowchart of patients with painful aseptic knee after total knee arthroplasty (TKA). PE: polyethylene, OA: osteoarthritis, AVN: avascular necrosis.

• 

  Fig. 2 Postoperative 5-year anteroposterior X-ray (A) and lateral X-ray (B) showing subsidence of the femoral component with osteolysis greater than 2 mm in width around the prosthesis in a 66-year-old female. Anteroposterior X-ray (C) and lateral X-ray (D) taken after revision total knee arthroplasty.

• 

  Fig. 3 Postoperative 2-year anteroposterior X-ray (A) and lateral X-ray (B) showing a decrease in the femorotibial distance defined as the shortest perpendicular distance from the femoral condyle to the tibial baseplate. Intraoperative photographs of the thin worn polyethylene inserts (C) and the thick revised polyethylene inserts (D).

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