This week it was a number of patients who had previous total knee replacements and have persistent pain that is nerve related.
This falls under the topic of Joint Denervation surgery. This technique involves evaluating certain sensory nerves that provide pain fibers to the joint capsules. We can perform denervation surgery on the shoulder, elbow, wrist, knee, ankle and now even the SI joint.
The most common patient we see for knee denervation surgery is someone who has had a total knee replacement or some other reconstructive surgery after trauma.
Often there has been an excellent replacement or reconstructive knee surgery, but there is some persistence of nerve related pain. So you can have a great initial surgery / reconstruction, but still have some irritated nerves that slow or halt your progress secondary to pain. Physical therapists are keenly aware of these problems and are very good at helping your surgeon identify these nerve issues.
If you are identified and referred to us by one of your providers ( or by yourself!) for an evaluation, there is a systematic evaluation of the nerves providing sensory innervation to the joint capsule. For instance, there are 6 cutaneous nerves that supply pain innervation to the anterior joint capsule of the knee. You could have only 1 or rarely all 6 involved. We determine the distribution of the pain, perform a focused physical examination and then determine which nerves are involved. These nerve(s) are then further confirmed by performing diagnostic blocks that support or rule out their involvement in the chronic knee pain. Once we have established which nerve(s) are involved, then subsequent treatment can be recommended. This may vary from repeat injections (with or without steroid) to nerve modalities to surgery. Patients will also be evaluated for nerve compression neuropathies that can happen within the region/area of the knee. It is not uncommon that if surgery is ultimately needed, then a combination of nerve decompression and sensory nerve excision are utilized to fully treat the pain.
Outcomes are very predictable if you utilize our logical steps to making an accurate diagnosis. Then treating with the appropriate stratified care model that we have developed.
If you have chronic knee pain after knee reconstruction from trauma or after total knee arthroplasty/replacement, you should see us to be evaluated for possible peripheral nerve involvement of your pain. There is no downside to this evaluation. Only the possibility of relief.