Peripheral nerve stimulation for the treatment of chronic knee pain

Abstract

The average age of our population is increasing, resulting in a high incidence of chronic degenerative knee pathologies. Several treatment options, including surgical procedures are available to help mitigate these pathologies. However, the percentage of subjects with chronic post-surgical knee pain is still estimated at 16–20%. Neuromodulation techniques such as spinal cord stimulation and dorsal root ganglion stimulation (DRGS) are treatment options for subjects with chronic knee pain. The evidence for peripheral nerve stimulation (PNS) is minimal due to a limited number of neuromodulation systems capable of targeting the distal part of the lower limbs. This study aimed to investigate the safety and efficacy externally powered PNS systems for the treatment of chronic intractable knee pain targeting the saphenous nerve. Patients suffering from chronic intractable post-surgical knee pain received landmark-guided peripheral nerve stimulation of the branches of the saphenous nerve. All implants were performed with an externally powered PNS system to avoid lead migration as a result of cross-joint lead positions tunneling towards an Implantable Pulse Generator to the trunk. Data were collected retrospectively. Subject-reported outcome was measured via numerical rating scale values on a 10-point scale measuring pain intensity at rest and in motion. Additional data were collected for the subjects treated at the Charité location, including quality of life with the SF-36 form, quality of sleep with the Pittsburgh Sleep Quality Index and mood states with the short form of the General Depression Scale. Thirty-three patients received direct to permanent implant, landmark-guided peripheral nerve stimulation of the saphenous nerve branches. Six (18.2%) subjects reported non-sufficient initial benefit from the therapy and were explanted. Two subjects were explanted due to wound infections. The total study population reported included 25 patients. These subjects reported significant improvements related to pain, quality of life, mood quality, and quality of sleep. Additionally, subjects were able to reduce their opioid medication significantly after PNS therapy. Externally powered PNS at the saphenous nerve branches is a straightforward, selective and safe technique for patients with chronic knee pain. The landmark-guided implantation technique is less invasive than classical neuromodulation techniques such as spinal cord or DRGS and complication rates remain low. Short-term results are promising and show considerable reductions in pain scores and opioid intake. Long-term results are pending.

Mechanisms and Preventative Strategies for Persistent Pain following Knee and Hip Joint Replacement Surgery: A Narrative Review

“…Interventional methods have been increasingly studied for their potential effectiveness. Peripheral nerve stimulation (PNS) at the saphenous nerve branches has emerged as a straightforward, selective, and safe technique for patients with chronic knee pain [114]. In a limited study conducted by Früh et al, participants who underwent PNS at the saphenous nerve branches had reduced opioid usage and significant improvements in quality of life, mood, and sleep [114].…”

“…Peripheral nerve stimulation (PNS) at the saphenous nerve branches has emerged as a straightforward, selective, and safe technique for patients with chronic knee pain [114]. In a limited study conducted by Früh et al, participants who underwent PNS at the saphenous nerve branches had reduced opioid usage and significant improvements in quality of life, mood, and sleep [114]. Additionally, neurolysis of the genicular nerve using radiofrequency is a potential treatment that has shown positive initial results in reducing pain and improving joint function [115].…”