Complex Regional Pain Syndrome Complicating Total Knee Arthroplasty

Abstract

Purpose.To compare the long-term outcome of patients diagnosed with complex regional pain syndrome-type 1 (CRPS-1) after total knee arthroplasty (TKA) with those of uncomplicated TKA knees and preoperative osteoarthritic knees. Methods. Medical records of 1280 patients who underwent TKA for osteoarthritis were retrospectively reviewed; 8 were diagnosed as having symptoms and signs consistent with CRPS after TKA. Patients with primary inflammatory arthritis, signs of component loosening, malpositioning, or of infected arthroplasty were excluded. No patient had signs of CRPS prior to operative intervention. The 8 patients were compared with 2 groups of age-and sex-matched controls: uncomplicated TKA knees and preoperative osteoarthritic knees. Patients were followed up for a mean of 54 (range, 13-111) months and their range of movement, Western Ontario and McMaster Universities Osteoarthritis Index, SF-36 questionnaire scores, and Knee Society scores were assessed and compared. Surgery 2006;14(3):280-3 arthritis Index, and Knee Society scores when compared with uncomplicated TKA patients. Scores for CRPS complicated patients were significantly improved when compared with preoperative osteoarthritic patients. The incidence of CRPS after TKA was 0.7%. Conclusion. When managed early, patients complicated with CRPS after TKA have a similar prognosis to patients with uncomplicated TKA. Journal of Orthopaedic

Type-I complex regional pain syndrome of umbilical port site: An unforeseen complication of laparoscopic surgery

“…[4] CRPS occurs hypothetically due to partial peripheral nerve injuries with distal degeneration of small-diameter peripheral axons and inappropriate firing and neurosecretion by residual axons with denervation supersensitivity. [5] Small-fiber axon damage also causes increased release of nor-epinephrine, which causes vascular symptoms locally and rise in temperature of the affected part. Indeed, small-fiber-predominant polyneuropathies cause CRPS-like abnormalities and small distal nerve injuries in rodents reproduce many CRPS features further supports this hypothesis.…”

Current Understandings on Complex Regional Pain Syndrome

“…Spontaneous CRPS is rare, 1,122 but does occur. In general, fractures are the most common precipitating events, and the upper extremity is more frequently involved than the lower 1,118,119 . Severity of the physical injury is not related to the risk of CRPS, 97,123,124 although in two studies CRPS patients more often had an intra‐articular localization of the fracture 125,126 .…”

“…Wrist fractures are considered the typical initiating trauma for CRPS, but the reported incidences after a wrist fracture vary broadly between 1% and 37% 116,117 . Incidences after other precipitating events vary as well, for example, between 0.7% and 21% after total knee prosthesis surgery, 118,119 and between 1.6% and 48.8% after a stroke 120,121 . The estimated incidence rates appear highly dependent on the applied diagnostic criteria, as well as the time between trauma and assessment of CRPS 119 …”

Complex regional pain syndrome of the knee – a case report

“…The aetiology of CRPS is not fully understood but involves an exaggeration of physiological responses and is now believed to occur on multiple levels within the central nervous system [5]. Prompt diagnosis and early treatment is most effective in altering the course of the disease [6], however making a definite diagnosis is difficult as no imaging or diagnostic modalities are specific for CRPS [7].…”

“…Though reports involving primarily the knee have been published [5,6,8], a general awareness of the syndrome involving the knee still needs to be increased, and considered in differential diagnosis, so that cases which arise following trauma or otherwise are readily recognized.…”