Partial denervation for persistent neuroma pain around the knee

Abstract

The authors present the results of denervation procedures treatment for 70 patients with persistent knee pain after total knee replacement, trauma, or osteotomy. In patients with total knee arthroplasty, aseptic loosening, sepsis, ligamentous instability, malalignment, and polyethylene wear had to be systematically ruled out as the source of pain. In patients with nontotal knee arthroplasty, arthrosis, synovitis, ligamentous instability, and meniscal derangement had been excluded as a source of pain. All candidates for the procedure had a successful selective nerve block. Sixty of the 70 (86%) patients were satisfied with the denervation procedure as judged by direct questioning and a reduction in their preoperative pain visual analog score of 5 or more points. The average Knee Society score improved from a preoperative mean of 51 points (range, 40-62 points) to a followup mean of 82 points (range, 15-100 points). Forty-nine of 70 (70%) patients had final Knee Society objective scores greater than 80. There was no difference in patient satisfaction whether the followup period was less than 2 years or more than 2 years. Selective knee denervation is indicated in the management of intractable knee pain after exhaustion of traditional approaches to any structural or infectious etiologies and after successful selective nerve block.