Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN.
Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN.
J Arthroplasty. 2021 Jun;36(6):2116-2120. doi: 10.1016/j.arth.2020.12.056. Epub 2021 Jan 7.
Diagnostic injections are commonly utilized in the workup of painful total knee arthroplasties (TKA), particularly when the diagnosis remains unclear. However, current literature provides limited evidence regarding the utility and prognostic capability of anesthetic injections in this scenario. This study sought to establish the role of diagnostic injections in predicting successful revision TKA.
A retrospective review was conducted on 144 consecutive aseptic revision TKAs receiving diagnostic anesthetic injections. Instability (57.6%) and aseptic loosening (33.3%) comprised most revision etiologies. Patient-reported percentage pain relief after the injection was statistically correlated with KOOS JR, Knee Society Score, UCLA Activity Level, and satisfaction scores.
About 74.3% (107/144) of revision TKAs reported >50% pain relief after injection. There were no differences in pain relief based on revision indication (P = .841). Improvement from preoperative activity level was greater in the >50% pain relief group (P = .024). Four-month patient satisfaction did not differ between patients who reported >50% and ≤50% pain relief (67% vs. 66%, P = .130). About 64% of patients who reported >50% pain relief were satisfied at minimum 1-year follow-up, compared with only 47% of those who reported ≤50% pain relief after diagnostic injection (P < .001).
Study results show that patients reporting >50% pain relief after diagnostic injection have improvements in activity level and maintain greater satisfaction at minimum 1-year than those reporting ≤50% pain relief. Expectations for improvement after revision TKA should be tempered if diagnostic anesthetic injection yields minimal subjective pain relief.
诊断性注射在治疗疼痛性全膝关节置换术（TKA）中被广泛应用，尤其是在诊断仍不明确的情况下。然而，目前的文献对这种情况下麻醉注射的效用和预后能力提供的证据有限。本研究旨在确定诊断性注射在预测成功翻修 TKA 中的作用。
对 144 例接受诊断性麻醉注射的无菌性翻修 TKA 进行回顾性研究。不稳定（57.6%）和无菌性松动（33.3%）构成了大多数翻修病因。注射后患者报告的疼痛缓解百分比与 KOOS JR、膝关节协会评分、UCLA 活动水平和满意度评分进行了统计学相关性分析。
约 74.3%（107/144）的翻修 TKA 报告注射后疼痛缓解>50%。根据翻修指征，疼痛缓解无差异（P=0.841）。>50%疼痛缓解组的术前活动水平改善更大（P=0.024）。报告>50%和≤50%疼痛缓解的患者在 4 个月时的满意度无差异（67%与 66%，P=0.130）。报告>50%疼痛缓解的患者中，约 64%在至少 1 年随访时感到满意，而报告诊断性注射后≤50%疼痛缓解的患者中，只有 47%感到满意（P<0.001）。
研究结果表明，报告诊断性注射后>50%疼痛缓解的患者在活动水平上有改善，并且在至少 1 年的随访中保持更高的满意度，而报告≤50%疼痛缓解的患者则不然。如果诊断性麻醉注射仅产生最小的主观疼痛缓解，那么对翻修 TKA 后改善的预期应该降低。
