Hôpital Privé de L'Estuaire, Ramsay Santé, Le Havre, France.
Hôpital Charles Nicolle, CHU de Rouen, Rouen, France.
Arch Orthop Trauma Surg. 2022 Jun;142(6):1109-1115. doi: 10.1007/s00402-021-03924-x. Epub 2021 May 10.
Arthrofibrosis develops in 3-10% of knees after total knee arthroplasty (TKA), which may result in pain and restricted range-of-motion. Treatment options include manipulation under anaesthesia, arthroscopic debridement, and quadricepsplasty, but there is little consensus on their efficacy for treatment of unexplained pain after TKA. The purpose of this study was to report the prevalence and characteristics of unexplained pain after TKA as revealed by arthroscopic exploration, and assess the efficacy of arthroscopic procedures to relieve pain.
From a consecutive series of 684 TKAs, 11 patients (1.6%) had unexplained pain at 7-48 months after TKA. Causes of pain remained unidentified after systematic and differential assessment, but arthroscopic exploration revealed fibrotic tissues, which were debrided during the same procedure. Patients were assessed first at 6-61 months and last at 90-148 months, with pain on a visual analog scale (pVAS) and range-of-motion recorded during both assessments, but Oxford Knee Score (OKS) and Forgotten Joint Score (FJS) only during the last assessment. Residual pain was classified as little or no pain (pVAS, 0-1), moderate pain (pVAS, 2-4), and severe pain (pVAS, 5-10).
At first follow-up (n = 11) pVAS improved by 4.1 ± 1.1 (p < 0.001), and range-of-motion improved by 5.0° ± 7.1° (p = 0.041). Seven patients (64%) had little or no residual pain, while four (36%) had moderate residual pain. At final follow-up (n = 9) pVAS improved by 3.2 ± 2.9 (p < 0.001), and range-of-motion improved by 4.4° ± 8.5° (p = 0.154). Six patients (67%) had little or no residual pain, while one (11%) had moderate and two (22%) had severe residual pain.
Arthroscopic exploration revealed that all 11 knees with unexplained pain had fibrotic tissues, the removal of which alleviated pain in only 67%, while moderate to severe pain persisted in 33% which merits further scrutiny.
全膝关节置换术（TKA）后，3-10%的膝关节会发生关节纤维僵直，可导致疼痛和活动范围受限。治疗方案包括麻醉下手法松解、关节镜下清理和股四头肌成形术，但对于 TKA 后不明原因疼痛的疗效，尚无共识。本研究旨在报告关节镜探查显示的 TKA 后不明原因疼痛的发生率和特征，并评估关节镜手术缓解疼痛的疗效。
连续 684 例 TKA 中，11 例（1.6%）在 TKA 后 7-48 个月时出现不明原因疼痛。经系统和鉴别评估后仍无法确定疼痛原因，但关节镜探查显示有纤维组织，在同一手术中进行了清理。患者分别在 6-61 个月和 90-148 个月时进行评估，两次评估时均记录视觉模拟评分（pVAS）和活动范围，仅在最后一次评估时记录牛津膝关节评分（OKS）和遗忘关节评分（FJS）。残留疼痛分为轻度或无疼痛（pVAS，0-1）、中度疼痛（pVAS，2-4）和重度疼痛（pVAS，5-10）。
初次随访时（n=11），pVAS 改善了 4.1±1.1（p<0.001），活动范围改善了 5.0°±7.1°（p=0.041）。7 例（64%）患者残留疼痛轻度或无，4 例（36%）患者残留疼痛中度。末次随访时（n=9），pVAS 改善了 3.2±2.9（p<0.001），活动范围改善了 4.4°±8.5°（p=0.154）。6 例（67%）患者残留疼痛轻度或无，1 例（11%）患者残留疼痛中度，2 例（22%）患者残留疼痛重度。
关节镜探查显示，11 例不明原因疼痛的膝关节均有纤维组织，去除纤维组织仅缓解了 67%的疼痛，而 33%的患者仍存在中重度疼痛，需要进一步研究。
