Reflex sympathetic dystrophy as a cause of poor results after total knee arthroplasty

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

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“…These findings are similar to those of other studies, 3,5 though with slightly greater ROM (2°-97°) at final follow-up than previously reported.…”

Section: Discussionsupporting

confidence: 92%

“…2 The incidence of CRPS after TKA is not well appreciated, as the literature has been limited to 72 cases. [3][4][5][6][7] Early references to CRPS after TKA estimated an incidence of between 0.8 and 1.2%.…”

Section: Discussionmentioning

confidence: 99%

Complex Regional Pain Syndrome Complicating Total Knee Arthroplasty

Burns

Parker

Coolican

et al. 2006

J Orthop Surg (Hong Kong)

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“…12 RSD in the upper limb is reported following carpal tunnel release (whether performed endoscopically 13,14 or operatively 15 ), Dupytrens repair 16,17 and other tendon release procedures. 18 RSD in the lower limb is a recognized complication of knee surgeryÐincluding tibial osteotomy 19,20 and arthroplasty 21 where it is associated with a poor prognosis. It is also reported following crush injury to the foot, 22 ankle arthrodesis, 23 amputation 24 and hip arthroplasty.…”

Section: What Triggers Rsd?mentioning

confidence: 99%

Reflex sympathetic dystrophy--a complex regional pain syndrome

Turner-Stokes

2002

Disability and Rehabilitation

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Reflex sympathetic dystrophy (RSD) is a complex and poorly-understood condition characterized by: (a) pain and altered sensation; (b) motor disturbance and soft tissue change; (c) vasomotor and autonomic changes; and (d) psychosocial disturbance. Neurological symptoms typically do not conform to any particular pattern of nerve damage. Many different names have been ascribed to this condition and most recently the term 'complex regional pain syndrome' has been coined to emphasize the complex interaction of somatic, psychological and behavioural factors. Diagnostic criteria have been proposed by the International Association for the Study of Pain, but are still subject to debate. This review article describes the clinical features which may present as part of the condition, and the patho-physiology and pre-disposing factors so far identified. The evidence for effectiveness of different interventions is presented and a treatment approach outlined for inter-disciplinary management. While RSD is traditionally associated with pain in the extremities, the possibility is raised that the same process may underlie chronic pain syndromes affecting more central structures, such as testicular or pelvic pain.

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“…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]. …”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

Complex regional pain syndrome of the knee – a case report

Pandita¹,

Arfath²

2013

BMC Sports Sci Med Rehabil

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Background: Persistent unexplained pain around the knee can be a perplexing problem. Reports of complex regional pain syndrome involving primarily knee have been published, yet complex regional pain syndrome of the knee is infrequently included in differential diagnosis of pain out of proportion. Case presentation: A 54 year old female presented to the physiotherapy outpatient department with complains of severe anterior knee pain and stiffness, persisting for more than 2 months post arthroscopic medial plical excision. The patient met the criteria for establishing a probable diagnosis of complex regional pain syndrome (CRPS) knee. Pressure algometre, goniometric measurements and knee outcome survey activities of daily living scale were used to document any changes. This patient was managed for a period of four sessions using graded desensitization therapy, TENS and mobilisation with feedback. Patient showed marked improvement in range of movement (ROM), hypersensitivity, pain and function. Conclusion: Meticulous examination, early diagnosis and prompt treatment resulted in a quick improvement in the patient's condition.

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Reflex sympathetic dystrophy as a cause of poor results after total knee arthroplasty

Cited by 59 publications

References 16 publications

Complex Regional Pain Syndrome Complicating Total Knee Arthroplasty

Complex Regional Pain Syndrome Complicating Total Knee Arthroplasty

Reflex sympathetic dystrophy--a complex regional pain syndrome

Complex regional pain syndrome of the knee – a case report

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