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Background <p>Neuropathic pain, weakness, and/or numbness can complicate partial or total knee arthroplasty (KA). This study evaluates peripheral nerve surgery following KA and proposes a treatment algorithm.</p> Methods <p>Patients who underwent peripheral nerve surgery for neuropathic symptoms (neuropathic pain and/or motor dysfunction) following KA between 2012–2024 (≥ 3-month follow-up) were included. Demographics, comorbidities, and type of treatment were collected, and a cross-sectional survey assessed satisfaction (Patient Global Impression of Change, PGIC) and quality of life (EuroQol-5-Dimension-5-Level, EQ-5D-5L).</p> Results <p>Twenty-seven lower extremities treated in 26 patients with a median age of 67.0&#xa0;years (IQR: 58.0–71.8) were included. Surgical indications included neuropathic pain (<i>n</i> = 24/27, 88.9%), foot drop (<i>n</i> = 1/27, 3.7%), or both (<i>n</i> = 2/27, 7.4%). Median time between KA and nerve surgery was 29.5&#xa0;months (IQR: 12.5–71.0). Procedures included saphenous or infrapatellar branch neurectomy with active management of the nerve ending (targeted muscle reinnervation (TMR) or regenerative peripheral nerve interface (RPNI)) (48.1%, <i>n</i> = 13), nerve decompression (40.7%, <i>n</i> = 11), or a combination of the two (11.1%, <i>n</i> = 3). Twenty-one patients (80.8%, 22 extremities) completed the survey with a median follow-up of 1.9&#xa0;years (IQR: 1.1–4.2). Improvement (PGIC) was reported in 21 extremities (95.5%), the mean EQ-5D-5L index was 0.854 (± 0.102) (US general population: 0.851 (± 0.205)).</p> Conclusion <p>Peripheral nerve surgery is beneficial for patients with neuropathic pain, numbness, and/or weakness following KA. We recommend common peroneal nerve decompression for lateral knee pain and/or foot drop, active saphenous nerve management with TMR or RPNI for medial knee pain, or a combination of the two based on the clinical scenario. These findings may aid in the decision-making process for patients with neuropathic pain following KA and warrant further validation in larger, prospective studies.</p>

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Surgical management of peripheral nerve symptoms following knee arthroplasty

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月6日

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  • Otis C. van Varsseveld,
  • Floris V. Raasveld,
  • Wen-Chih Liu,
  • Justin McCarty,
  • Caroline A. Hundepool,
  • J. Michiel Zuidam,
  • Ian L. Valerio,
  • Kyle R. Eberlin

摘要

Background

Neuropathic pain, weakness, and/or numbness can complicate partial or total knee arthroplasty (KA). This study evaluates peripheral nerve surgery following KA and proposes a treatment algorithm.

Methods

Patients who underwent peripheral nerve surgery for neuropathic symptoms (neuropathic pain and/or motor dysfunction) following KA between 2012–2024 (≥ 3-month follow-up) were included. Demographics, comorbidities, and type of treatment were collected, and a cross-sectional survey assessed satisfaction (Patient Global Impression of Change, PGIC) and quality of life (EuroQol-5-Dimension-5-Level, EQ-5D-5L).

Results

Twenty-seven lower extremities treated in 26 patients with a median age of 67.0 years (IQR: 58.0–71.8) were included. Surgical indications included neuropathic pain (n = 24/27, 88.9%), foot drop (n = 1/27, 3.7%), or both (n = 2/27, 7.4%). Median time between KA and nerve surgery was 29.5 months (IQR: 12.5–71.0). Procedures included saphenous or infrapatellar branch neurectomy with active management of the nerve ending (targeted muscle reinnervation (TMR) or regenerative peripheral nerve interface (RPNI)) (48.1%, n = 13), nerve decompression (40.7%, n = 11), or a combination of the two (11.1%, n = 3). Twenty-one patients (80.8%, 22 extremities) completed the survey with a median follow-up of 1.9 years (IQR: 1.1–4.2). Improvement (PGIC) was reported in 21 extremities (95.5%), the mean EQ-5D-5L index was 0.854 (± 0.102) (US general population: 0.851 (± 0.205)).

Conclusion

Peripheral nerve surgery is beneficial for patients with neuropathic pain, numbness, and/or weakness following KA. We recommend common peroneal nerve decompression for lateral knee pain and/or foot drop, active saphenous nerve management with TMR or RPNI for medial knee pain, or a combination of the two based on the clinical scenario. These findings may aid in the decision-making process for patients with neuropathic pain following KA and warrant further validation in larger, prospective studies.