Castine Abigayle M, Robinson Christopher L, Fair Richard N, Varrassi Giustino, Shekoohi Sahar, Kaye Alan D
College of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA.
Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
Cureus. 2024 Aug 19;16(8):e67223. doi: 10.7759/cureus.67223. eCollection 2024 Aug.
Osteoarthritis, the most common joint disease of adults worldwide, is increasing in prevalence due to an increase in aging and rates of obesity in developed countries. Treatment options include physical therapy, pharmacologic management, non-pharmacologic management, and total knee replacement surgery. When conservative measures fail, total knee replacement surgery is pursued. The patient is a 61-year-old woman with a history of severe chronic osteoarthritic knee pain following total left and right knee arthroplasty in 2016 and 2019, respectively, who presents with refractory post-total knee replacement pain. Following her surgeries, the patient was in excruciating 10/10 pain on the numerical rating scale (NRS) and was unable to walk or stand. She underwent revisions which, unfortunately, did not ameliorate her pain. She was later referred to chronic pain management in which a peripheral nerve stimulator (PNS) was offered and implanted. Following her PNS trial, the patient achieved >80% pain relief in her left knee. After the permanent PNS implant, the patient noted she had 100% pain relief (0/10 on the NRS) in her left knee and was able to regain mobility. Here, we discuss a case demonstrating rapid pain relief following the minimally invasive PNS implantation for refractory pain following total knee arthroplasty. Refractory pain following total knee arthroplasty can increase morbidity and mortality as a consequence. Thus, proper management is needed to reduce these adverse outcomes. In patients who have failed conservative medical management, PNS may be an alternative, efficacious treatment option for refractory knee pain. Despite the efficacy in our case, further research is needed to define the optimal patient group that would benefit from PNS for refractory knee pain following total knee arthroplasty.
骨关节炎是全球成年人中最常见的关节疾病，在发达国家，由于老龄化加剧和肥胖率上升，其患病率正在增加。治疗选择包括物理治疗、药物治疗、非药物治疗和全膝关节置换手术。当保守治疗失败时，会选择全膝关节置换手术。该患者为一名61岁女性，分别于2016年和2019年进行了左、右全膝关节置换术，之后出现严重的慢性骨关节炎膝关节疼痛，目前表现为全膝关节置换术后顽固性疼痛。手术后，患者在数字评分量表（NRS）上的疼痛评分为10分中的10分，剧痛难忍，无法行走或站立。她接受了翻修手术，但不幸的是，疼痛并未减轻。后来她被转诊至慢性疼痛管理部门，在那里接受了外周神经刺激器（PNS）的植入。在进行PNS试验后，患者左膝疼痛缓解超过80%。永久性PNS植入后，患者表示左膝疼痛完全缓解（NRS评分为0/10），并能够恢复活动能力。在此，我们讨论一例病例，该病例显示了在全膝关节置换术后顽固性疼痛的微创PNS植入后疼痛迅速缓解。全膝关节置换术后的顽固性疼痛可能会增加发病率和死亡率。因此，需要适当的管理来减少这些不良后果。对于保守药物治疗失败的患者，PNS可能是治疗顽固性膝关节疼痛的一种替代且有效的治疗选择。尽管我们的病例显示了疗效，但仍需要进一步研究来确定从PNS治疗全膝关节置换术后顽固性膝关节疼痛中获益的最佳患者群体。
