PARTIAL DENERVATION FOR PERSISTENT NEUROMA PAIN AFTER TOTAL KNEE ARTHROPLASTY

Despite the high percentage of patients who are satisfied completely w ith Mle results of total knee arthroplasty, there is a small group who remain disabled because of persistent neuroma pain, Recently, a bette r understanding of the innervation of the skin and capsule around the human knee joint has provided a theoretical basis for denervation in t his group of patients, Fifteen patients were identified who had persis tent or worse knee pain for >6 months after total knee arthroplasty, I n each patient, component loosening, malalignment, knee instability, a nd infection had been excluded systematically as a source of pain, Pai n was evaluated preoperatively with the Knee Society Functional Score Questionnaire and a visual analog scale, To be selected for surgery, e ach patient must have had a reduction by 5 points on the visual analog ue scale for pain after undergoing selective nerve blocks, Postoperati ve assessment was done by a team that did not include the surgeon who did the denervation, The technique for selective knee denervation is d escribed in detail, All 15 patients had at least 1 of the nerves to th e knee selectively denervated (45 nerves in 15 patients). All patients reported subjective improvement in the immediate postoperative period , This improvement was maintained Id a mean followup of 12 months (ran ge, 6-16 months). Selective knee denervation is indicated in the manag ement of intractable knee pain of neuroma origin after total knee arth roplasty.