Infrapatellar Saphenous Neuralgia After TKA Can Be Improved With Ultrasound-guided Local Treatments

Abstract

Background Current opinion suggests that in some patients, chronic pain after total knee arthroplasty (TKA) has a neuropathic origin. Injury to the infrapatellar branch of the saphenous nerve (IPSN) has been implicated as a cause of medial knee pain; however, local treatments for this condition remain controversial. Questions/purposes We sought to explore the efficacy of local treatment to the IPSN in patients with persistent medial knee pain after TKA.

Letter to the Editor: Infrapatellar Saphenous Neuralgia After TKA Can Be Improved With Ultrasound-guided Local Treatments

“…Peripheral and central sensitization could potentially be associated with chronic intractable pain in knee osteoarthritis [2]. Although the present research supports the role of peripheral neuralgia in relentless postarthroplasty knee pain [1], central sensitization might partly account for the patients failing to respond to nerve block. Therefore, oral medication modifying central pain perception can be considered in combination with medication targeting nociceptive pain [3].…”

“…W e read the retrospective case series conducted by Clendenen and colleagues and appreciate their efforts in exploring a patient population with infrapatellar saphenous neuralgia after TKA [1]. Their research indicates ultrasound-guided injection to the infrapatellar branch of the saphenous nerve is a potential approach for recalcitrant pain following TKA.…”

Reply to the Letter to the Editor: Infrapatellar Saphenous Neuralgia After TKA Can Be Improved With Ultrasound-guided Local Treatments

“…In our Results section, we noted that 13 of the 16 patients (81%) showed improved pain scores of at least 50% after our treatment [1]. Ten of the patients reported pain scores of 0 or 1 out of 10 and were very satisfied with their results.…”

Towards an understanding of the painful total knee: what is the role of patient biology?

“…Neuropathic pain affects about 11 % of patients undergoing primary TKA and has its peak incidence between 6 weeks and 3 months postoperatively [50]. Injury to the infrapatellar branch of saphenous nerve has been implicated as a common extra-articular cause of persistent knee pain [51,52]. Complex regional pain syndrome (CRPS) is a less common cause of painful total knee replacement.…”