Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2021; 12(12): 1008-1015
Published online Dec 18, 2021. doi: 10.5312/wjo.v12.i12.1008
Surgical treatment outcome of painful traumatic neuroma of the infrapatellar branch of the saphenous nerve during total knee arthroplasty
Byron Chalidis, Dimitrios Kitridis, Panagiotis Givissis
Byron Chalidis, Dimitrios Kitridis, Panagiotis Givissis, The First Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 57010, Greece
Author contributions: Chalidis B designed the research; Kitridis D analyzed the data; Chalidis B and Kitridis D wrote the paper; Givissis P supervised the paper; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Byron Chalidis, MD, PhD, Surgeon, The First Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Exohi, Thessaloniki 57010, Greece. byronchalidis@gmail.com
Received: April 1, 2021
Peer-review started: April 1, 2021
First decision: July 28, 2021
Revised: August 11, 2021
Accepted: December 7, 2021
Article in press: December 7, 2021
Published online: December 18, 2021
Processing time: 256 Days and 10.8 Hours
Abstract
BACKGROUND

Development of infrapatellar saphenous neuroma (ISN) is a well-recognized reason for knee pain following total knee arthroplasty (TKA). So far, very few studies have addressed the development of painful ISN after TKA and its impact on functional outcome and patient satisfaction.

AIM

To present the results of surgical treatment for ISN after primary TKA, the level of pain relief, and the improvement of knee motion and function.

METHODS

Fifteen patients (13 women, 2 men) with persistent medial pain for more than six months after primary TKA, due to osteoarthritis, underwent surgical excision of ISN. ISN diagnosis was confirmed with the presence of Tinel’s sign along the course of the infrapatellar branch of the saphenous nerve and with pain relief after selective nerve block using local anesthetic. Component loosening, malalignment, instability and infection were excluded systematically in all patients as a source of pain. Pain relief in terms of visual analog scale (VAS), active knee range of motion (ROM), and the Knee Society Score (KSS) for pain and function were evaluated preoperatively and at least six months postoperatively.

RESULTS

The mean patients’ age was 71.3 ± 5.4 years old. The mean interval between TKA and neuroma excision was 10 mo (range, 6 to 14 mo), while the mean follow-up was 8 mo (range: 6 to 11 mo). All 15 patients experienced almost complete immediate pain relief and resolution of allodynia and hyperesthesia after surgery. Pain on the VAS scale improved from 8.6 ± 1.3 preoperatively to 0.8 ± 0.9 at the final follow-up (P = 0.001). KSS pain and function scores were improved from 49.3 ± 5.9 and 62.7 ± 12.8 before surgery to 91.8 ± 4.2 and 75.3 ± 11.3 after surgery, respectively (P = 0.001 and P = 0.015). Active knee ROM was also increased postoperatively from 96 ± 4 to 105 ± 6 degrees (P = 0.001). There were no complications and no further operations required.

CONCLUSION

ISN should be considered a potential cause of persistent pain following TKA. Neuroma excision not only provides immediate pain relief and resolution of symptoms but may also improve the knee range of motion.

Keywords: Total knee arthroplasty; Infrapatellar branch of saphenous nerve; Neuroma; Neurogenic pain; Knee osteoarthritis

Core Tip: Development of infrapatellar saphenous neuroma after total knee arthroplasty should be considered a potential reason for persistent pain in an otherwise non-infected, well-fixed, and well-aligned joint. Before total knee arthroplasty, patients should be warned for the risk of nerve injury and neuroma formation. Neuroma excision provides excellent pain relief and improves knee function and range of motion.