Diagnostic Algorithm for Residual Pain After Total Knee Arthroplasty
Diagnostic Algorithm for Residual Pain After Total Knee Arthroplasty
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DOI：
10.3928/01477447-20160119-06
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发表时间：
2016-03-01
期刊：
影响因子：
1.1
通讯作者：
Ranawat, Chitranjan S.
中科院分区：
文献类型：
--
作者：
Park, Caroline N.;White, Peter B.;Ranawat, Chitranjan S.
尽管全膝关节置换术是一种成功且具有成本效益的手术，但患者的满意度仍然高达 50%。全膝关节置换术后残留的膝关节疼痛，无论是否伴有捻发音，是导致患者不满意的一个主要因素。全膝关节置换术后残留疼痛最常见的部位是前方。由于残余疼痛与未修复的髌骨有关，因此本次综述仅包括登记数据和髌骨置换的全膝关节置换术。一些人认为残余膝关节疼痛的发病机制可能与激活髌股关节周围游离神经末梢的机械刺激有关。残余疼痛涉及多种病因，包括（1）低度感染，（2）中屈曲不稳定，以及（3）组件排列不齐伴髌骨轨迹不良。不太常见的原因包括（4）捻发音和髌骨沉闷综合征； (5) 髌股症状，包括髌骨过度充盈和股骨头缺血性坏死； (6)早期无菌性松动； (7)对金属或水泥过敏； (8)复杂区域疼痛综合征； (9)假性动脉瘤。由于所有这些情况都可能导致残余疼痛，因此确定病因可能是一个困难的诊断挑战。通常，持续疼痛且放射线照片和实验室检查结果正常的患者可能会受益于诊断注射或进一步成像。然而，高达 10% 至 15% 的残余疼痛患者可能会出现无法解释的疼痛。本文献综述总结了残余疼痛原因的研究结果，并提出了一种诊断算法，以促进全膝关节置换术后残余疼痛的准确诊断。
Although total knee arthroplasty is a successful and cost-effective procedure, patient dissatisfaction remains as high as 50%. Postoperative residual knee pain after total knee arthroplasty, with or without crepitation, is a major factor that contributes to patient dissatisfaction. The most common location for residual pain after total knee arthroplasty is anteriorly. Because residual pain has been associated with an un-resurfaced patella, this review includes only registry data and total knee arthroplasty with patella replacement. Some suggest that the pathogenesis of residual knee pain may be related to mechanical stimuli that activate free nerve endings around the patellofemoral joint. Various etiologies have been implicated in residual pain, including (1) low-grade infection, (2) midflexion instability, and (3) component malalignment with patellar maltracking. Less common causes include (4) crepitation and patellar clunk syndrome; (5) patellofemoral symptoms, including overstuffing and avascular necrosis of the patella; (6) early aseptic loosening; (7) hypersensitivity to metal or cement; (8) complex regional pain syndrome; and (9) pseudoaneurysm. Because all of these conditions can lead to residual pain, identifying the etiology can be a difficult diagnostic challenge. Often, patients with persistent pain and normal findings on radiographs and laboratory workup may benefit from a diagnostic injection or further imaging. However, up to 10% to 15% of patients with residual pain may have unexplained pain. This literature review summarizes the findings on the causes of residual pain and presents a diagnostic algorithm to facilitate an accurate diagnosis for residual pain after total knee arthroplasty.