Surgical management of peripheral nerve symptoms following knee arthroplasty

Abstract

Background: Neuropathic pain, weakness, and/or numbness can complicate partial or total knee arthroplasty (KA). This study evaluates peripheral nerve surgery following KA and proposes a treatment algorithm. Methods: Patients who underwent peripheral nerve surgery for neuropathic symptoms (neuropathic pain and/or motor dysfunction) following KA between 2012–2024 (≥ 3-month follow-up) were included. Demographics, comorbidities, and type of treatment were collected, and a cross-sectional survey assessed satisfaction (Patient Global Impression of Change, PGIC) and quality of life (EuroQol-5-Dimension-5-Level, EQ-5D-5L). Results: Twenty-seven lower extremities treated in 26 patients with a median age of 67.0 years (IQR: 58.0–71.8) were included. Surgical indications included neuropathic pain (n = 24/27, 88.9%), foot drop (n = 1/27, 3.7%), or both (n = 2/27, 7.4%). Median time between KA and nerve surgery was 29.5 months (IQR: 12.5–71.0). Procedures included saphenous or infrapatellar branch neurectomy with active management of the nerve ending (targeted muscle reinnervation (TMR) or regenerative peripheral nerve interface (RPNI)) (48.1%, n = 13), nerve decompression (40.7%, n = 11), or a combination of the two (11.1%, n = 3). Twenty-one patients (80.8%, 22 extremities) completed the survey with a median follow-up of 1.9 years (IQR: 1.1–4.2). Improvement (PGIC) was reported in 21 extremities (95.5%), the mean EQ-5D-5L index was 0.854 (± 0.102) (US general population: 0.851 (± 0.205)). Conclusion: Peripheral nerve surgery is beneficial for patients with neuropathic pain, numbness, and/or weakness following KA. We recommend common peroneal nerve decompression for lateral knee pain and/or foot drop, active saphenous nerve management with TMR or RPNI for medial knee pain, or a combination of the two based on the clinical scenario. These findings may aid in the decision-making process for patients with neuropathic pain following KA and warrant further validation in larger, prospective studies.