Evaluation of Pain Syndrome in Patients after Total Knee Replacement

Cover Page


Cite item

Full Text

Abstract

Total joint replacement is one the most effective methods for treatment of degenerative, systemic and posttraumatic diseases of the knee. However, up to 25% of patients remain dissatisfied with surgery outcomes. In the majority of cases the patients complain of pain in the operated joint. Identification of pain cause in the operated joint can turn to become a challenge for the surgeon.

Purpose of the study — to identify the causes of pain syndrome basing on examination algorithm in patients after TKR as well as to assess the diagnostic value of each particular examination method.

Materials and Methods. The authors analyzed results of comprehensive examination of 79 patients who complained of chronic knee pain after primary TKR and seeked medical help from the beginning of 2016 until December 2018. Inclusion criteria were as follows: knee prosthesis and presence of pain syndrome in the operated joint. Exclusion criteria: fistulous peri-prosthetic infection, suspected “culture-negative” infection and revisions. All patients included into the study were managed according to the standard algorithm of comprehensive examination.

Results. The most likely causes of pain were identified during the examination. Infection was observed in 39 patients (49.4%), errors in three-dimensional positioning of components was considered as a probable cause of pain in 14 patients (17.7%), aseptic loosening was reported in 13 cases (16.5%), ligamentous instability — in 6 patients (7.6%), extraarticular pain origin was observed in 5 patients (6.3%) and peri-prosthetic fractures were reported in two patients (2.5%). The authors confirmed a combination of several pain causes in 17 patients (21.5%).

Conclusion. Examination of patients with painfull knee joint prosthesis should be comprehensive due to potential combination of issues in each particular case. Integral and systematic approach to pain diagnostics in the operated joint is the “key to success” for planning further treatment tactics and for understanding the necessity and scope of revision procedure.

About the authors

V. Yu. Murylev

Sechenov First Moscow State Medical University; Botkin Moscow City Hospital

Author for correspondence.
Email: nmuril@yandex.ru

Valery Yu. Murylev — Dr. Sci (Med.), professor, Department of Traumatology, Orthopaedic and Disaster Surgery; head of Moscow City arthroplasty Centre

Moscow

Russian Federation

S. S. Alekseev

Sechenov First Moscow State Medical University; Botkin Moscow City Hospital

Email: fake@neicon.ru

Semen S. Alekseev — PhD student; orthopaedic surgeon

Moscow

Russian Federation

P. M. Elizarov

Sechenov First Moscow State Medical University; Botkin Moscow City Hospital

Email: fake@neicon.ru

Pavel M. Elizarov — cand. Sci. (Med.), assistant professor, Department of Traumatology, Оrthopaedics and Disaster Surgery; orthopaediс surgeon

Moscow

Russian Federation

G. A. Kukovenko

Sechenov First Moscow State Medical University; Botkin Moscow City Hospital

Email: fake@neicon.ru

Grigorii A. Kukovenko — PhD student; orthopaediс surgeon

Moscow

Russian Federation

A. A. Dering

Botkin Moscow City Hospital

Email: fake@neicon.ru

Alexey A. Dering — orthopaedic surgeon, the head of orthopaediс Department

Moscow

Russian Federation

T. H. Haptagaev

Sechenov First Moscow State Medical University

Email: fake@neicon.ru

Timur H. Haptagaev — PhD student

Moscow

Russian Federation

References

  1. Baker P.N., Van Der Meulen J.H., Lewsey J., Gregg P.J. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National joint Registry for england and Wales. J Bone Joint Surg Br. 2007;89(7):893-900. doi: 10.1302/0301-620x.89B7.19091.
  2. Scott C.E., Howie C.R., Macdonald D., Biant L.C. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br. 2010;92(9):1253–1258. doi: 10.1302/0301-620x.92B9.24394.
  3. Bourne R.B., Chesworth B.M., Davis A.M., Mahomed N.N., Charron K.D.J. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468(1):57-63. doi: 10.1007/s11999-009-1119-9.
  4. Hofmann S., Seitlinger G., Djahani O., Pietsch M. The painful knee after TKA: a diagnostic algorithm for failure analysis. Knee Surg Sports Traumatol Arthrosc. 2011;19(9):1442-1452. doi: 10.1007/s00167-011-1634-6.
  5. Schroer W.C., Berend K.R., Lombardi A.V., Barnes C.L., Bolognesi M.P., Berend M.E. et al. Why are Total Knees failing Today? etiology of Total Knee Revision in 2010 and 2011. J Arthroplasty. 2013;28(8 Suppl):116-119. doi: 10.1016/j.arth.2013.04.056.
  6. Hardcastle J.M., So D.H., Lee G.C. The fate of Revision Total Knee arthroplasty With Preoperative abnormalities in either Sedimentation Rate or c-Reactive Protein. J Arthroplasty. 2016;31(12):2831–2834. doi: 10.1016/j.arth.2016.05.044.
  7. Seil R., Pape D. causes of failure and etiology of painful primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2011;19(9):1418–1432. doi: 10.1007/s00167-011-1631-9.
  8. Khan M., Osman K., Green G., Haddad F.S. The epidemiology of failure in total knee arthroplasty. Bone Joint J. 2016;98-B(1 Suppl a):105-112. doi: 10.1302/0301-620x.98B1.36293
  9. Парратте С., Корнилов Н.Н., Тиенпонт Э., Балдини А., Тихилов Р.М., Аргенсон Ж., Куляба Т.А. Необъяснимая боль после тотального эндопротезирования колен-ного сустава. Травматология и ортопедия России. 2013;(4):92-96. doi: 10.21823/2311-2905-2013--4-92-96.
  10. Burns A., Parker D., Coolican M., Rajaratnam K. Complex Regional Pain Syndrome complicating Total Knee arthroplasty. J Orthop Surg (Hong-Kong). 2006;14(3): 280-283. doi: 10.1177/230949900601400309.
  11. Kornilov N., Lindberg M.F., Gay C., Saraev A., Kuliaba T., Rosseland L.A. et al. Higher physical activity and lower pain levels before surgery predict non-improvement of knee pain 1 year after TKA. Knee Surg Sport Traumatol Arthrosc. 2018;26(6):1698-1708. doi: 10.1007/s00167-017-4713-5.
  12. Insall J., Salvati E. Patella position in the normal knee joint. Radiology. 1971;101(1):101-104. doi: 10.1148/101.1.101.
  13. Blackburne J.S, Peel T.E. a new method of measuring patellar height. J Bone Joint Surg Br. 1977;59(2):241-242.
  14. Behrend H., Graulich T., Gerlach R., Spross C., Ladurner A. Blackburne–Peel ratio predicts patients’ outcomes after total knee arthroplasty. Knee Surg Sport Traumatol Arthrosc. 2019;27(5):1562-1569. doi: 10.1007/s00167-018-5016-1.
  15. Berger R.A., Crossett L.S., Jacobs J.J., Rubash H.E. Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res. 1998;(356):144-153. doi: 10.1097/00003086-199811000-00021.
  16. Berger R.A., Crossett L.S. Determining the rotation of thefemoral and tibial components in total knee arthroplasty: a computer tomography technique. Oper Tech Orthop. 1998;8(3):128-133. doi: 10.1016/S1048-6666(98)80022-0.
  17. Momoli A., Giaretta S., Modena M., Micheloni G.M. The painful knee after total knee arthroplasty: evaluation and management. Acta Biomed. 2017;88(2S):60-67. doi: 10.23750/abm.v88i2-S.6515.
  18. Merchant A.C., Mercer R.L., Jacobsen R.H., Cool C.R. Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am. 1974;56(7):1391-1396.
  19. Parvizi J., Fassihi S.C., Enayatollahi M.A. Diagnosis of periprosthetic joint infection following hip and knee arthroplasty. Orthop Clin North Am. 2016;47(3):505-515. doi: 10.1016/j.ocl.2016.03.001.
  20. Ghanem E., Houssock C., Pulido L., Han S., Jaberi F.M., Parvizi J. Determining „true“ leukocytosis in bloody joint aspiration. J Arthroplasty. 2008;23(2):182-187. doi: 10.1016/j.arth.2007.08.016.
  21. Tsukayama D.T., Estrada R., Gustilo R.B. Infection after total hip arthroplasty. a study of the treatment of one hundred and six infections. J Bone Joint Surg Am.1996;78(4): 512-523. doi: 10.2106/00004623-199604000-00005.
  22. Abdel Karim M., Andrawis J., Bengoa F., Bracho C., Compagnoni R., Cross M. et al. Hip and knee section, diagnosis, algorithm: proceedings of international consensus on orthopedic infections. J Arthroplasty. 2019;34(2S):S339-S350. doi: 10.1016/j.arth.2018.09.018.
  23. Manrique J., Gomez M., Parvizi J. Stiffness after total knee arthroplasty. J Knee Surg. 2015;28(2):119-126. doi: 10.1055/s-0034-1396079.
  24. Pitta M., Esposito C.I., Li Z., Lee Y., Wright T.M., Padgett D.E. Failure after modern total knee arthroplasty: a prospective study of 18,065 Knees. J Arthroplasty. 2018;33(2):407-414. doi: 10.1016/j.arth.2017.09.041.
  25. Cheuy V.A., Foran J.R.H., Paxton R.J., Bade M.J., Zeni J.A., Stevens-Lapsley J.E. Arthrofibrosis associated with total knee arthroplasty. J Arthroplasty. 2017;32(8):2604-2611. doi: 10.1016/j.arth.2017.02.005.
  26. Rutherford R.W., Jennings J.M., Levy D.L., Parisi T.J., Martin J.R., Dennis D.A. Revision total knee arthroplasty for arthrofibrosis. J Arthroplasty. 2018;33(7):S177-S181. doi: 10.1016/j.arth.2018.03.037.
  27. Boldt J.G., Stiehl J.B., Hodler J., Zanetti M., Munzinger U. Femoral component rotation and arthrofibrosis following mobile-bearing total knee arthroplasty. Int Orthop. 2006;30(5):420-425. doi: 10.1007/s00264-006-0085-z.
  28. Panni A.S., Ascione F., Rossini M., Braile A., Corona K., Vasso M, Hirschmann M.T. Tibial internal rotation negatively affects clinical outcomes in total knee arthroplasty: a systematic review. Knee Surg Sport Traumatol Arthrosc. 2018;26(6):1636-1644. doi: 10.1007/s00167-017-4823-0.
  29. Bell S.W., Young P., Drury C., Smith J., Anthony I., Jones B. Et Al. Component rotational alignment in unexplained painful primary total knee arthroplasty. Knee. 2014;21(1):272-277. doi: 10.1016/j.knee.2012.09.011.
  30. Жиженкова Т.В., Даниляк В.В., Ключевский В.В., Ключевский В.В. Оценка нестабильности надколенни-ка после тотального эндопротезирования коленного сустава. Травматология и ортопедия России.2015;(2): 24-31. doi: 10.21823/2311-2905-2015-0-2-24-31.
  31. Della Valle C., Parvizi J., Bauer T.W., Dicesare P.E., Evans R.P., Segreti J. et al. American academy of orthopaedic Surgeons clinical practice guideline on: the diagnosis of periprosthetic joint infections of the hip and knee. J Bone Joint Surg Am.2011;93(14):1355-1357. doi: 10.2106/jBjS.9314ebo.
  32. Parvizi J., Gehrke T. Definition of periprosthetic joint infection. J Arthroplasty. 2014;29(7):1331. doi: 10.1016/j.arth.2014.03.009.
  33. Ettinger M., Calliess T., Kielstein J.T., Sibai J., Brückner T., Lichtinghagen R. et al. Circulating biomarkers for discrimination between aseptic joint failure, low-grade infection, and high-grade septic failure. Clin Infect Dis. 2015;61(3):332-341. doi: 10.1093/cid/civ286.
  34. Corvec S., Portillo M.E. Pasticci B.M., Borens O., Trampuz A. Epidemiology and new developments in the diagnosis of prosthetic joint infection. Int J Artif Organs. 2012;35(10):923-934. doi: 10.5301/ijao.5000168.
  35. Berbari E., Mabry T., Tsaras G., Spangehl M., Erwin P.J., Murad M.H. et al. Steckelberg J., Osmon D. Inflammatory blood laboratory levels as markers of prosthetic joint infection. J Bone Joint Surg Am. 2010;92(11):2102-2109. doi: 10.2106/jBjS.I.01199.
  36. Pérez-Prieto D., Portillo M.E., Puig-Verdié L., Alier A., Martínez S., Sorlí L. et al. C-Reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections. Int Orthop. 2017;41(7):1315-1319. doi: 10.1007/s00264-017-3430-5
  37. Винклер Т., Трампуш А., Ренц Н., Перка К., Божкова С.А. Классификация и алгоритм диагностики и ле-чения перипротезной инфекции тазобедренного сустава. Травматология и ортопедия России. 2016;(1): 33-45. doi: 10.21823/2311-2905-2016-0-1-33-45.
  38. Божкова СА. Современные принципы диагностики и антибактериальной терапии инфекции протезированных суставов (обзор литературы). Травматология и ортопедия России. 2011;3(61):126-136. doi: 10.21823/2311-2905-2011-0-3-126-13639.
  39. Crawford L., Kumar A., Shepard G. Gouty synovitis after total knee arthroplasty: a casec report. J Orthop Surg (Hong Kong). 2007;15(3):384-385. doi: 10.1177/230949900701500330.
  40. Berger J.S., Weinik M.M. Acute gouty arthropathy mimicking infection after total knee arthroplasty. PM R. 2009;1(3):284-286. doi: 10.1016/j.pmrj.2008.11.007.
  41. Fokter S.K., Repše-Fokter A. Acute gouty arthritis in a patient after total knee arthroplasty. Wien Klin Wochenschr. 2010;122(11–12):366-367. doi: 10.1007/s00508-010-1384-3.
  42. Shohat N., Bauer T., Buttaro M., Budhiparama N., Cashman J., Della Valle C.J. et al. Hip and knee section, what is the definition of a periprosthetic joint infection (PjI) of the knee and the hip? can the same criteria be used for both joints?: Proceedings of international consensus on orthopedic infections. J Arthroplasty. 2019;34(2):S325-S327. doi: 10.1016/j.arth.2018.09.045.
  43. Trampuz A., Hanssen A.D., Osmon D.R., Mandrekar J., Steckelberg J.M., Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med. 2004;117(8):556-562. doi: 10.1016/j.amjmed.2004.06.022.
  44. Zimmerli W., Trampuz A., Ochsner P.E. Prostheticjoint infections. N Engl J Med. 2004;351(16):1645-1654. doi: 10.1056/NejMra040181.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c)


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies