Zhou Wenhui, Bultman Eric, Mandl Lisa A, Giori Nicholas J, Kishore Sirish A
Department of Radiology, Stanford University Medical Center, Stanford, CA, USA.
Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA.
CVIR Endovasc. 2024 Jan 3;7(1):4. doi: 10.1186/s42155-023-00409-3.
Chronic knee pain after total knee arthroplasty (TKA) is a common complication that is difficult to treat. This report aims to highlight the benefit of combining embolotherapy and neurolysis intervention for symptomatic relief of post-TKA pain in a patient with long-standing pain refractory to conservative management.
A 77-year-old man who had previously undergone left knee arthroplasty has been grappling with worsening knee effusion and debilitating pain, resulting in limited mobility and progressive musculature deconditioning over a 20-year period. Diagnostic arteriography showed marked diffuse periarticular hyperemia around the medial and lateral joint spaces of the left knee, along with capsular distention. The patient initially underwent microsphere embolization to selectively target multiple branches of the genicular arteries, achieving a 50% reduction in pain at the one-month follow-up. Subsequently, the patient underwent image-guided genicular nerve neurolysis, targeting multiple branches of the genicular nerves, which led to further pain reduction (80% compared to the initial presentation or 60% compared to post-embolization) at the one-month follow-up. This improvement facilitated weight-bearing and enabled participation in physical therapy, with sustained pain relief over the 10-month follow-up period.
The combination of genicular artery embolization and genicular nerve block may be a technically safe and effective option for alleviating chronic pain after total knee arthroplasty.
全膝关节置换术（TKA）后慢性膝关节疼痛是一种常见且难以治疗的并发症。本报告旨在强调对于一名经保守治疗长期疼痛难治的TKA术后患者，联合栓塞治疗和神经松解干预在缓解症状性疼痛方面的益处。
一名77岁男性，既往接受过左膝关节置换术，在20年的时间里一直饱受膝关节积液加重和疼痛困扰，导致活动受限和肌肉逐渐失用。诊断性血管造影显示左膝关节内外侧关节间隙周围明显弥漫性关节周围充血，伴有关节囊扩张。患者最初接受微球栓塞，选择性地靶向膝动脉的多个分支，在1个月的随访中疼痛减轻了50%。随后，患者接受了影像引导下的膝神经松解术，靶向膝神经的多个分支，在1个月的随访中疼痛进一步减轻（与初始表现相比减轻80%，与栓塞后相比减轻60%）。这种改善促进了负重，并使患者能够参与物理治疗，在10个月的随访期内疼痛持续缓解。
膝动脉栓塞和膝神经阻滞相结合可能是缓解全膝关节置换术后慢性疼痛的一种技术上安全有效的选择。
