Numbness Around the Total Knee Arthroplasty Surgical Scar: Prevalence and Effect on Functional Outcome

Jariwala, Arpit; Parthasarathy, Avinash; Kiran, Manish; Johnston, Linda; Rowley, D.I.

doi:10.1016/j.arth.2017.01.057

Cited by 20 publications

(33 citation statements)

References 11 publications

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“…With the escalation of the incidence of TKAs reaching new heights, their postoperative complications must be carefully considered and studied by orthopedic surgeons. 1,4,9,[15][16][17][18] A wellknown postoperative complication, especially from the commonly used midline incision, is the injury to the IPBSN. 1-3,9,14,22 Being a purely sensory nerve running down the anteromedial aspect of the knee, the damage to the distal part of the IPBSN by midline incision often leads to paresthesia, hypersensitivity, or numbness of the lateral and potentially even medial and anterior parts of the knee.…”

Section: Discussionmentioning

confidence: 99%

“…With the current incidence of TKA being over 300,000 in the United states annually and the per capita utilization of TKAs among patients with Medicare projected to escalate nearly 300% by 2025, complications of TKA, whether small or large, look to cause significant morbidity for the growing population of patients undergoing TKAs. 1,4,9,[15][16][17][18] A common approach used in TKA is the midline approach. A well-known postoperative complication of such approach is infrapatellar branch of the saphenous nerve (IPBSN) injury, which results in paresthesia and anesthesia of the anterior skin of the knee.…”

Section: Introductionmentioning

confidence: 99%

“…A well-known postoperative complication of such approach is infrapatellar branch of the saphenous nerve (IPBSN) injury, which results in paresthesia and anesthesia of the anterior skin of the knee. [1][2][3]5,9,10,12,14,19,22 IPBSN is a purely sensory nerve innervating the medial, anterior, and part of the lateral aspect of the knee and anteroinferior knee joint capsule. 1,9,12,22 It is one of the two branches that originate from the saphenous nerve, the longest cutaneous branch of the femoral nerve, 1,8,12 and runs superficially between the tibial tubercle and the apex of the patella.…”

Section: Introductionmentioning

confidence: 99%

“…5,11,12,21 The prevalence of the damage to the nerve as a postoperative complication has been reported in some studies to range from 0.5 to 30% and in others as high as 53%. 9,14 Once damaged, patients note numbness, paresthesia, or hypersensitivity of lateral skin flap of the knee. 7,9,11,13,20,21 Although the knee function largely remains intact, IPBSN injury can lead to patient dissatisfaction by affecting the ability of the patient to kneel in fear of damaging the prosthesis due to their sensory deficits.…”

Section: Introductionmentioning

confidence: 99%

“…9,14 Once damaged, patients note numbness, paresthesia, or hypersensitivity of lateral skin flap of the knee. 7,9,11,13,20,21 Although the knee function largely remains intact, IPBSN injury can lead to patient dissatisfaction by affecting the ability of the patient to kneel in fear of damaging the prosthesis due to their sensory deficits. 6,13 In light of the disagreement in current literature on whether improvement of IPBSN damage ever occurs with time, surgeons should attempt to minimize intraoperative injury to the nerve or its branches.…”

Section: Introductionmentioning

confidence: 99%

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Cadaveric study of the infrapatellar branch of the saphenous nerve: Can damage be prevented in total knee arthroplasty?

Lee

Dahlgren

Staggers

et al. 2019

Journal of Clinical Orthopaedics and Trauma

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Background: The infrapatellar branch of the saphenous nerve (IPBSN) is a purely sensory nerve innervating the anteromedial aspect of the knee and anteroinferior knee joint capsule. Total knee arthroplasty (TKA) is commonly used to treat end-stage arthritis, but the IPBSN is often injured and results in numbness around the anteromedial knee. The aim of this cadaveric study was to describe the course and variability of the IPBSN and to assess whether it is possible to preserve during a standard midline surgical approach in TKA. Methods: Ten fresh-frozen cadaver legs were dissected using a midline approach to the knee. Skin and subcutaneous flap were reflected to expose both the saphenous nerve and its branches. The branches of the IPBSN were identified, and their vertical distances above the tibial tuberosity (TB) were recorded: TB to inferior branch, to middle branch, and to superior branch. Results: There were 10 left-sided specimens (6 female, 4 male) with a mean age of 79.9 AE 9.8 years. 8 (80%) specimens had 2 branches of IPBSN while 2 (20%) specimens had 3 branches. The average distance from TB to the inferior branch was 16.8 AE 8.3 mm (3.0-28.0); middle branch, 24.0 AE 1.4 mm (23.0-24.9); and superior, 45.9 AE 7.7 mm (32.0-54.5). Conclusion: Our cadaveric study found no consistent way to preserve the IPBSN using a standard midline approach in TKA. It is important to provide proper patient education on this complication, and surgeons should be aware of approximate locations and variations of IPBSN while performing other knee procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Cadaveric study of the infrapatellar branch of the saphenous nerve: Can damage be prevented in total knee arthroplasty?

Lee

Dahlgren

Staggers

et al. 2019

Journal of Clinical Orthopaedics and Trauma

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The kneeling test is a valid method of assessing kneeling tolerance

Calvert

Smith

Kuster

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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PurposeNo quantitative test exists to reliably assess kneeling tolerance before and after surgery. The aim of this study was to validate a kneeling test, designed to quantify kneeling tolerance. MethodA total of 179 participants (324 knees) were enrolled into the study, including 124 asymptomatic knees, 98 with osteoarthritis (OA), 85 following total knee arthroplasty (TKA) and 17 following anterior cruciate ligament reconstruction (ACLR). Patients were asked to kneel on a custom‐built platform on a soft, firm and hard surface, at both 90° and 110° of knee flexion. A kneeling score of 0–100 was established for 90° and 110° with 100 being a complete absence of pain or discomfort. A linear mixed model with random intercept was used to estimate differences between conditions (healthy, OA, ACLR and TKA). Pearson’s correlation coefficient was used to test the strength of the association between the kneeling test and the forgotten joint score (FJS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Test–retest reliability was estimated by the intraclass correlation coefficient (ICC). ResultsThe kneeling test demonstrated good discriminative validity with differences at 110° between asymptomatic knees and knees with OA (difference = − 42, p < 0.001), following ACLR (− 12, p = 0.013) and TKA (− 26, p < 0.001). Similar differences were observed at 90°. The kneeling test demonstrated construct validity, with a moderately strong correlation observed between the kneeling test and the FJS and the WOMAC at 90° (FJS 0.474 [95%CI: 0.357, 0.577], WOMAC − 0.503 [− 0.389, − 0.602]) and 110° (FJS 0.579 [95% CI: 0.479, 0.665], WOMAC − 0.648 [− 0.560, − 0.722]). The ICC for the kneeling test at 90° and 110° was 0.843 (95% CI: 0.745, 0.905) and 0.926 (95% CI: 0.877, 0.956), respectively. ConclusionsThe kneeling test is a valid technique to quantitatively determine kneeling tolerance. It can aid in the assessment and modification of current surgical techniques to improve patient outcomes. Level of evidenceIII.

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The objective measurement of hypoaesthesia after Total Knee Arthroplasty and its correlation with skin incision length: a prospective study

Prabhu,

Kothari,

Keny

et al. 2024

International Orthopaedics (SICOT)

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Numbness Around the Total Knee Arthroplasty Surgical Scar: Prevalence and Effect on Functional Outcome

Cited by 20 publications

References 11 publications

Cadaveric study of the infrapatellar branch of the saphenous nerve: Can damage be prevented in total knee arthroplasty?

Cadaveric study of the infrapatellar branch of the saphenous nerve: Can damage be prevented in total knee arthroplasty?

The kneeling test is a valid method of assessing kneeling tolerance

The objective measurement of hypoaesthesia after Total Knee Arthroplasty and its correlation with skin incision length: a prospective study

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