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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 8, 1042-1045.
doi: 10.1302/0301-620X.89B8.19389  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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A conservative approach is feasible in unexplained pain after knee replacement

A SELECTED COHORT STUDY

D. W. Elson, MRCS, Clinical Research Fellow in Orthopaedics1; and I. J. Brenkel, BSc, FRCSEd, Consultant Orthopaedic Surgeon2

1 Wrightington Hospital, Hall Lane, Apley Bridge, Wigan WN6 9EP, UK.
2 Department of Orthopaedics Queen Margaret’s Hospital, Whitefield Road, Dunfermline, Fife KY12 0SU, UK.

Correspondence should be sent to Mr I. J. Brenkel; e-mail: ivanbrenkel{at}yahoo.co.uk

Pain is the main indication for performing total knee replacement (TKR). In most patients after TKR there is an improvement, but a few continue to have pain. Generally, the cause of the pain can be addressed when it is identified. However, unexplained pain can be more difficult to manage because revision surgery is likely to be unrewarding in this group. In our study of 622 cemented TKRs in 512 patients with a mean age of 69 years (23 to 90) treated between January 1995 and August 1998, we identified 24 patients (knees) with unexplained pain at six months. This group was followed for five years (data was unavailable for 18 knees) and ten patients (55.5%) went on to show an improvement without intervention.

In the case of unexplained pain, management decisions must be carefully considered, but reassurance can be offered to patients that the pain will improve in more than half with time.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General