Stocks Gregory W, Odoemene Melissa, Gex Julia, Vidal Emily A, Sawyer Kathryn, Jones Stephen L, Thompson Brandon, Laughlin Mitzi S
Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, Texas.
Fondren Orthopedic Research Institute (FORI), Houston, Texas.
J Bone Joint Surg Am. 2023 Mar 15;105(6):455-461. doi: 10.2106/JBJS.22.00703. Epub 2023 Jan 9.
Thigh pain is relatively common after total knee arthroplasty (TKA) and has been attributed to compression of the thigh muscles by the tourniquet used during surgery. Thigh pain that occurs after a TKA that was performed without a tourniquet may be due to a strain of the quadriceps muscle or insertion of the intramedullary (IM) rod. The purpose of the present study was to determine the cause of thigh pain after TKA in a randomized controlled trial evaluating tourniquet use, IM rod use, and quadriceps strain.
This prospective randomized controlled trial enrolled 97 subjects undergoing primary knee arthroplasty into 4 groups according to tourniquet use (yes or no) and IM rod use (yes or no). Quadriceps strain was evaluated with magnetic resonance imaging (MRI) on postoperative day 1 (POD 1). Data collected preoperatively, intraoperatively, and postoperatively until the 6-week clinical visit included pain levels for the knee and thigh (recorded separately) and knee range of motion.
Regardless of tourniquet or IM rod use, 73 (75%) of the 97 patients reported thigh pain on POD 1. Thigh pain at 2 weeks postoperatively was indicative of a quadriceps strain. Use of a tourniquet and patient-reported thigh pain at 2 weeks increased the odds of a quadriceps strain, whereas IM rod use did not significantly contribute to thigh pain.
The etiology of thigh pain after TKA may be multifactorial; however, an iatrogenic quadriceps strain is one source of thigh pain after TKA, especially if the pain persists 2 weeks after surgery.
Prognostic Level I . See Instructions for Authors for a complete description of levels of evidence.
全膝关节置换术（TKA）后大腿疼痛较为常见，其原因被认为是手术中使用的止血带对大腿肌肉的压迫。在未使用止血带的TKA术后出现的大腿疼痛可能是由于股四头肌拉伤或髓内（IM）棒的植入。本研究的目的是在一项评估止血带使用、IM棒使用和股四头肌拉伤的随机对照试验中确定TKA术后大腿疼痛的原因。
这项前瞻性随机对照试验将97例行初次膝关节置换术的受试者根据止血带使用情况（是或否）和IM棒使用情况（是或否）分为4组。在术后第1天（POD 1）通过磁共振成像（MRI）评估股四头肌拉伤情况。术前、术中和术后直至6周临床访视收集的数据包括膝关节和大腿的疼痛程度（分别记录）以及膝关节活动范围。
无论是否使用止血带或IM棒，97例患者中有73例（75%）在POD 1报告有大腿疼痛。术后2周的大腿疼痛表明存在股四头肌拉伤。使用止血带和患者在2周时报告的大腿疼痛增加了股四头肌拉伤的几率，而IM棒的使用对大腿疼痛没有显著影响。
TKA术后大腿疼痛的病因可能是多因素的；然而，医源性股四头肌拉伤是TKA术后大腿疼痛的一个来源，特别是如果疼痛在手术后持续2周。
预后水平I。有关证据水平的完整描述，请参阅作者指南。
