Successful Management of Chronic Postsurgical Pain Following Total Knee Replacement

Abstract

We report reversal of chronic postsurgical pain (CPSP) along with functional restoration after total knee replacement (TKR) in two patients, using a combination therapy that included ultrasonography-guided pulsed radiofrequency (PRF) of nerves supplying the knee to provide pain relief, along with dry needling (DN) to relax myofascial triggers/bands that caused painful stiffness and restricted movement of muscles acting across the knee. Both patients showed demonstrable pain relief, as evidenced by changes in pain as assessed on the Numeric Rating Scale (patient 1: 4-9/10 [pre-treatment] to 0-3/10 [6 months post-treatment]; patient 2: 5-9/10 to 0-4/10), Oxford Knee Score (patient 1: 17 to 40; patient 2: 12 to 39), Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs score (patient 1: 16 to 0; patient 2: 18 to 0), and Patient Health Questionnaire-9 score (patient 1: 17 to 2; patient 2: 20 to 2). The selection of the PRF-and-DN combination for treating post-TKR CPSP was based on a new idea that CPSP is a neuromyopathic phenomenon involving both sensory and motor neuropathy. It has evolved from our experience of 8 years. Physiotherapy worked synergistically with DN, optimizing muscle performance and pain relief.

Musculoskeletal Ultrasonography to Distinguish Muscle Changes in Complex Regional Pain Syndrome Type 1 from Those of Neuropathic Pain: An Observational Study

“…We proposed a concept of "neuromyopathy" to describe the pain and stiffness associated with osteoarthritis of knee as well as postsurgical neuropathic pain after knee replacement. 51,52 A similar neuromyopathy concept might explain the motor impairment of both the groups in this study. Neuromyopathy of CRPS was invariably associated with the severe disability in all 7 patients with CRPS, while the neuromyopathy of NeuP appeared to follow a relatively more benign course commensurate with the relatively subdued motor impairment.…”

“…The involvement of muscles in both NeuP and CRPS implies a possible involvement of the muscles per se , in addition to the sensory and motor nerves. We proposed a concept of “neuromyopathy” to describe the pain and stiffness associated with osteoarthritis of knee as well as postsurgical neuropathic pain after knee replacement . A similar neuromyopathy concept might explain the motor impairment of both the groups in this study.…”

Ultrasound guided chronic pain interventions (Part I)

“…Vas et al performed US guided PRF in two patients who had chronic postsurgical pain after total knee replacement (TKR). [39] PRF was applied to saphenous, tibial, common peroneal nerves and peripatellar, subsartorial and popliteal plexus. Dry needling was performed with US at the same time.…”

The effects of dry needling and radial extracorporeal shockwave therapy on latent trigger point sensitivity in the quadriceps: A randomised control pilot study

“…Previous studies that have investigated TrPs in the vastus lateralis (VL) and vastus medialis (VM) have focused on patients with pathologies such as knee osteoarthritis and patellofemoral pain syndrome (Espí-L opez et al, 2017;Vas et al, 2014). There is a substantial gap in the literature about the effects of latent TrPs, especially in the lower limb, on athletic performance.…”