Anterior knee pain after a total knee arthroplasty: What can cause this pain?

Abstract

Total Knee Arthroplasty has been shown to be a successful procedure for treating patients with osteoarthritis, and yet approximately 5%-10% of patients experience residual pain, especially in the anterior part of the knee. Many theories have been proposed to explain the etiology of this anterior knee pain (AKP) but, despite improvements having been made, AKP remains a problem. AKP can be described as retropatellar or peripatellar pain, which limits patients in their everyday lives. Patients suffering from AKP experience difficulty in standing up from a chair, walking up and down stairs and riding a bicycle. The question asked was: "How can a 'perfectly' placed total knee arthroplasty (TKA) still be painful: what can cause this pain?". To prevent AKP after TKA it is important to first identify the different anatomical structures that can cause this pain. Greater attention to and understanding of AKP should lead to significant pain relief and greater overall patient satisfaction after TKA. This article is a review of what pain is, how nerve signalling works and what is thought to cause Anterior Knee Pain after a Total Knee Arthroplasty.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words:Anterior knee pain; Patellofemoral pain; Total knee arthroplasty; Malrotation; Homeostasis Core tip: Total knee arthroplasty (TKA) has been shown to be a successful procedure for treating patients with osteoarthritis, and yet approximately 5%-10% of patients experience anterior knee pain (AKP). To prevent AKP after TKA it is important to first identify the different anatomical structures that can cause this pain. Greater attention to and understanding of AKP should lead to significant pain relief and greater overall patient satisfaction after TKA. This article is a review of what pain is, how nerve signalling works and what is thought to cause AKP after a TKA.Breugem SJM, Haverkamp D. Anterior knee pain after a total knee arthroplasty: What can cause this pain? World

Lateral facetectomy decreased patellofemoral contact pressure in total knee replacement: A cadaveric study

“…1,2 It was reported that 5-10% of patients had anterior knee pain after TKR. 3 Resurfacing or patellar non-resurfacing in TKR is still a controversial topic among surgeons. [4][5][6] The benefit of patellar non-resurfacing is to avoid patellar complications such as patella fracture, prosthesis wear, and future loosening of the implant.…”

Towards an understanding of the painful total knee: what is the role of patient biology?

“…However, AKP remains a problem even with more recent TKA designs that have presumably optimized the patellofemoral implant interface. Improper placement of the patellar button in patellofemoral resurfacing has also been linked with patellar maltracking, increased pressure across the patellofemoral joint, issues with patellar height, and anterior pain and stiffness following TKA [33]. This could be an important factor that might explain why secondary patellar resurfacing is not uniformly effective in alleviating AKP following TKA [35,36].…”

“…The design of the femoral and patellar components of TKA has also come into question as a potential contributor to AKP, independent of whether or not the patella is resurfaced. Some authors have suggested that incongruities between the two surfaces that may lead to patellar maltracking or instability are a potential source of pain [33]. However, AKP remains a problem even with more recent TKA designs that have presumably optimized the patellofemoral implant interface.…”

“…The prevalence of AKP has been reported between 0.4 and 49 %, with more recent estimates in the range of 5-10 % [33]. The etiology of AKP appears to be multifactorial.…”

“…There is an immense body of literature dedicated to the potential association between patellar resurfacing and AKP. Nevertheless, a debate persists as to whether patellar resurfacing is indicated in TKA, with no clear evidence to suggest that AKP can be eliminated by replacing the patellofemoral joint [33,34]. The design of the femoral and patellar components of TKA has also come into question as a potential contributor to AKP, independent of whether or not the patella is resurfaced.…”