REFLEX SYMPATHETIC DYSTROPHY FOLLOWING TOTAL KNEE ARTHROPLASTY

Reflex Sympathetic Dystrophy (RSD) complicating total knee arthroplast y was identified in seven patients, five females and two males, using the diagnostic criteria of an inordinately painful knee with marked li mitation of motion in the absence of other causes. Average age was 54 years (range: 32-69 years). Preoperative diagnosis included inflammato ry arthritis in three, osteoarthritis in two, failed patellar implant arthroplasty in one and failed cementless total knee arthroplasty in o ne. Follow-up averaged 2.1 years. Three patients diagnosed early (aver age: 1.6 months) received physical therapy alone, while three patients diagnosed later (average: 3.3 months) received physical therapy with sympathetic block. One patient diagnosed late (12 months) underwent re vision surgery and therapy. In the physical therapy only group, the av erage total active motion (TAM) improved from 63 to 105 and the HSS kn ee score improved from an average of 58 pre-operatively to 77 post-tre atment. In the block plus therapy group, average TAM improved from 50 to 85 and the HSS knee score improved from an average of 59 pre-operat ively to 81 post-treatment. The late diagnosis patient had improvement in TAM from 55 to 65 and HSS knee score from 36 to 64 following revis ion arthroplasty and physical therapy. All patients reported mild nons pecific pain at follow-up. Early diagnosis and aggressive treatment ca n improve range of motion and functional recovery but some degree of n onspecific pain may persist. Sympathetic block is a useful adjunct but not always required.