The painful knee after total knee arthroplasty

Becker, Roland; Bonnin, Michel; Hofmann, S.

doi:10.1007/s00167-011-1625-7

Cited by 29 publications

(22 citation statements)

References 12 publications

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“…External rotation of the femoral component leads to lateral positioning of the sulcus and preserves sulcus height which facilitates a more anatomic orientation of the trochlear groove [27] . This rotation also achieves a balanced flexion gap [2,5] . Therefore it is crucial for TKA systems to have instrumentation that allows for perfect external rotation of the femoral component in order to reproduce a more natural patellofemoral joint [25,27] .…”

Section: Femoral Component Rotationmentioning

confidence: 95%

“…However, other studies showed that there is no difference in anterior knee pain between resurfaced and unresurfaced patellae [53] . While many of the unresurfaced knees underwent secondary resurfacing due to anterior knee pain, revision surgery did not always resolve the pain [2] . Despite differing findings regarding the association of patellar resurfacing and decreased knee pain, many researchers suggest that surgeons employ at least selective resurfacing, based on factors such as patellar height and patient age [54] .…”

Section: Design Features Of the Patellar Component Which Reduce Patelmentioning

confidence: 99%

“…However, despite the implementation of such innovations, as few as 43% of patients report being completely pain free following a primary TKA procedure [2] . While pain alone is seldom utilized as a criterion for revision surgery, it is estimated that 2% of all TKAs ultimately fail due to pain.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have been conducted to determine the cause of anterior knee pain following TKA with variable results. Patient related factors that may contribute to increased pain following TKA include younger age, female gender, and ethnicity while modifiable non-patient related factors include prosthesis design as well as surgical error [2,[6][7][8] . In fact, up to 41.1% of patients have been found to experience patellofemoral complications related to these modifiable elements [9,10] .…”

Section: Introductionmentioning

confidence: 99%

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Anterior knee pain following primary total knee arthroplasty

Shervin¹,

Pratt²,

Healey³

et al. 2015

WJO

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Despite improvements in technique and technology for total knee arthroplasty (TKA), anterior knee pain impacts patient outcomes and satisfaction. Addressing the prosthetic and surgical technique related causes of pain after TKA, specifically as it relates to anterior knee pain, can aid surgeons in addressing these issues with their patients. Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/ flange combination; asymmetric patellar resurfacing, improper transverse plane component rotation resulting in patellar subluxation/tilt. Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator. As the number of TKA procedures continues to increase, it is increasingly critical to develop improved, evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications. MINIREVIEWSSubmit a

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Section: Femoral Component Rotationmentioning

confidence: 95%

Section: Design Features Of the Patellar Component Which Reduce Patelmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Anterior knee pain following primary total knee arthroplasty

Shervin¹,

Pratt²,

Healey³

et al. 2015

WJO

View full text Add to dashboard Cite

show abstract

“…Scott Dye [ 2 ] highlighted several years ago the importance of matching patient expectations with the possible result after knee surgery. A recent study showed that while 85 % of patients expect a completely painless knee following TKR, only 43 % actually achieve it [ 3 ]. Among the activities that patients expect to be able to perform after TKR, the most common are gardening and kneeling.…”

mentioning

confidence: 99%

25 Medical History and Physical Examination

Lustig

Magnussen

Duthon³

et al. 2015

The Unhappy Total Knee Replacement

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Chronic, Active Inflammation in Patients With Failed Total Knee Replacements Undergoing Revision Surgery

Paish

Baldock

Gillespie

et al. 2019

Journal Orthopaedic Research

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Chronic pain and restricted knee motion is a significant problem following the total knee arthroplasty (TKA). The molecular pathogenesis of pain post‐TKA is not known and no targeted therapeutic intervention is available. The aim of this study was to investigate whether pro‐inflammatory mediators are elevated in revision knee patients, indicating an active, ongoing inflammatory process that may contribute to pain. Twelve key markers (pro‐inflammatory cytokines granulocyte‐macrophage colony‐stimulating factor [GM‐CSF], interleukin 5 [IL‐5], IL‐8 and IL‐10, chemokines CCL2, CCL3, CCL4, and CCL13, mediators of angiogenesis Flt‐1, vascular endothelial growth factor, and cell migration vascular cell adhesion molecule 1 and intercellular adhesion molecule 1) were measured in knee tissue and synovial fluid (SF) from primary TKA (n = 29) and revision patients (n = 32). Indications for surgery were osteoarthritis (OA) for primary TKA, and component loosening (n = 11), stiffness (n = 11), laxity pattern (n = 8), or progression of OA in patella resurfacing (n = 3) for revision surgery. Pain levels (WOMAC score) were higher in revision than primary patients (p ≤ 0.05). Time from primary to revision ranged from 8 months to 30 years (median 10 years). All markers were elevated in revision TKA; there was no trend toward decreasing levels with greater time from primary surgery for any marker studied in SF. Similar results were seen in knee tissue. We found no differences comparing indications for revision surgery (p ≥ 0.05). The elevation of inflammatory mediators in painful post‐TKA knees requiring revision suggests active, chronic inflammation. Characterization of upregulated markers provides rationale for targeted therapy, even many years from the primary surgery. © 2019 The Authors. Journal of Orthopaedic Research ® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2316–2324, 2019

show abstract

The painful knee after total knee arthroplasty

Cited by 29 publications

References 12 publications

Anterior knee pain following primary total knee arthroplasty

Anterior knee pain following primary total knee arthroplasty

25 Medical History and Physical Examination

Chronic, Active Inflammation in Patients With Failed Total Knee Replacements Undergoing Revision Surgery

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