Disclosures: Gaurav Sunny Sharma, MD: Nothing to disclose

Case Description: A 77-year-old female was evaluated for chronic intractable right knee pain refractory to total knee arthroplasty (TKA) performed over 20 years ago. Since that time, patient has tried a variety of treatments including physical therapy, opiates, and revision surgery without significant relief. Her constellation of symptoms suggested complex regional pain syndrome (CRPS), however she did not respond to a lumbar sympathetic block or lumbar 4-5 transforaminal epidural steroid injection. Patient also underwent trial of dorsal column spinal cord stimulation (SCS), but again did not experience relief.

Setting: Tertiary Care Hospital

Patient: 77-year-old female

Assessment/Results: A trial of peripheral nerve stimulation (PNS) with two 8-contact stimulator leads along the superomedial and superolateral flares of the femoral condyle in the region of the genicular nerves was performed. The patient experienced 90-95% relief in symptoms and reported significantly improved function during the trial period. Implantation was then performed with two 4-contact stimulator leads. She reported significantly decreased pain and improved ambulation at her 1-week post-op appointment, which was maintained 3 months post-operatively.

Discussion: TKA is an accepted and effective treatment for severe knee osteoarthritis, however, a portion of patients continue to have persistent pain post-operatively. Neuromodulation, including SCS and PNS, has been an attractive therapy in the treatment of chronic pain. Both SCS and PNS have been shown to improve intractable knee pain following TKA in small case studies. We have not seen a case of successful PNS for this condition after prior unsuccessful SCS trial. Further studies to explore patient factors which may predict positive outcomes with either SCS or PNS in the treatment of intractable knee pain following TKA are warranted.

Conclusion: Peripheral nerve stimulation can be an effective treatment modality for chronic intractable knee pain following TKA and should be considered within the treatment algorithm.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/peripheral-nerve-stimulation-for-the-treatment-of-refractory-knee-pain-after-total-knee-arthroplasty/