Literature review of the causes of pain following total knee replacement surgery: prosthesis, inflammation and arthrofibrosis

Abstract

Adverse knee pain occurs in 10–34% of all total knee replacements (TKR), and 20% of TKR patients experience more pain post-operatively than pre-operatively. Knee pain is amongst the top five reasons for knee replacement revision in the United Kingdom. The number of TKRs is predicted to continue increasing due to the ageing population. A narrative literature review was performed on the different causes of pain following TKR. A database search on Scopus, PubMed, and Google Scholar was conducted to look for articles related to TKR, pain, and cause. Articles were selected based on relevance, publication date, quality of research and validation. Relevant sections were added to the review. One hundred and fourteen articles were identified and potential causes of TKR pain included: arthrofibrosis, aseptic loosening, avascular necrosis, central sensitization, component malpositioning, infection, instability, nerve damage, overstuffing, patellar maltracking, polyethylene wear, psychological factors and unresurfaced patella. It is important to tailor our approach to address the individual causes of pain. Certain controllable risk factors can be managed pre-operatively to minimize post-operative pain. Risk factors help to predict adverse pain outcomes and identify specific causes. There are multiple causes of pain following TKR. Some factors will require further extensive studies, and as pain is a commonly attributed reason for TKR revision, its underlying aetiologies should be explored. Understanding these factors helps to develop effective methods for diagnosis, prevention and management of TKR pain, which help to improve patient outcomes. Cite this article: EFORT Open Rev 2020;5:534-543. DOI: 10.1302/2058-5241.5.200031

Early Clinical and Radiographic Outcomes of Robot‐Assisted Versus Conventional Manual Total Knee Arthroplasty: A Randomized Controlled Study

“…Although there have been tremendous improvements in surgical techniques and postoperative rehabilitation, approximately 20% of patients are unsatisfied after primary TKA 2 , with anterior knee pain as one of the most common causes of dissatisfaction 3 . Other causes reported in the literature include polyethylene liner wear and knee instability 4 , which are all related to improper prosthetic component placement 5 . In previous TKA surgeries, especially in patients with severe KOA, it was difficult for even experienced surgeons to ensure precise intraoperative placement of the prosthesis due to the severe deformity of the knee.…”

Factors Associated with The Efficiency of Platelet-Rich Plasma Injection Among Patients with Knee Osteoarthritis: A Retrospective Data Analysis

“…Especially, PRP treatment can signi cantly decrease the expression of in ammatory factors (IL-18, IL-1β, and TNF-α) and suppress relevant in ammation pathway [6] . Such pathways are proven to be over-active in knee pain model [7] , which might explain why PRP treatment have a greater performance in KOA patients with more pain. Besides, PRP treatment is famous for its excellent pain relief function.…”

A retrospective case series of prophylactic neurectomy during total knee arthroplasty

“…Reasons for this pain are numerous and can be attributed to both intra-articular and extraarticular causes. 3,4 Often, postoperative pain necessitates an extensive evaluation with 20% of patients ultimately unsatisfied following the replacement due to continued pain with no identifiable cause. [5][6][7] Neuroma formation is often overlooked as a reason for unexplained postoperative pain.…”