Often we will see a patient who had a knee replacement procedure and continue to have pain following the surgery. Studies suggest that this may be caused by the high number of possible post-surgery knee replacement complications.
Knee Replacement Complications
Researchers writing in the medical journal Clinical Orthopaedics and Related Research noted that “Despite the importance of complications in evaluating patient outcomes after total knee replacement (TKA), definitions of TKA complications are not standardized. Different investigators report different complications with different definitions when reporting outcomes of TKA.” So that there was a need to develop a standardized list and definitions of complications and adverse events associated with TKA.
Here is the list
1. bleeding
2. wound complication
3. thromboembolic disease
4. neural deficit
5. vascular injury
6. medial collateral ligament injury
7. instability
8. stiffness
9. deep joint infection
10.fracture
11.patellofemoral dislocation
12.tibiofemoral dislocation
13.bearing surface wear
14.osteolysis
15.implant loosening
16.implant fracture/tibial insert dissociation
17.reoperation
18.revision
19.readmission
20.malalignment
21.extensor mechanism disruption
22.death. (1)
Prolotherapy
Research appearing in the Journal of Alternative and Complementary Medicine says “In adults with moderate to severe knee osteoarthritis, dextrose prolotherapy may result in safe, significant, sustained improvement of knee pain, function, and stiffness scores.”(2)
“The main risk of prolotherapy is pain and mild bleeding as a result of needle trauma. Patients frequently report pain, a sense of fullness and occasional numbness at the injection site at the time of injections.
These side effects are typically self-limited. A post-injection pain flare during the first 72 hours after the injections is common clinically but its incidence has not been well documented. An ongoing study of prolotherapy for knee OA pain has noted that 10–20% of subjects experience such flares. Pain flares are likewise typically self-limited, and usually respond well to acetaminophen (500–650 mg every four hours as needed).
On rare occasions, the occurrence of strong, post-injection pain may require treatment with narcotic medication. Non-steroidal anti-inflammatory agents are not routinely used after the procedure, but may be indicated if the pain does not resolve with other measures. Most patients with pain flares experience diminution of pain in 5–7 days after injections; regular activities can be resumed at this time.” (3)
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1. Complications of Total Knee Arthroplasty: Standardized List and Definitions of The Knee Society.
Healy WL, Della Valle CJ, Iorio R, Berend KR, Cushner FD, Dalury DF, Lonner JH. Complications of Total Knee Arthroplasty: Standardized List and Definitions of The Knee Society. Clin Orthop Relat Res. 2012 Jul 19. [Epub ahead of print]
2. Rabago D, Zgierska A, Fortney L, Hypertonic dextrose injections (prolotherapy) for knee osteoarthritis: results of a single-arm uncontrolled study with 1-year follow-up. J Altern Complement Med. 2012 Apr;18(4):408-14.
3. Rabago D, et al. Prolotherapy in Primary Care Practice. Prim Care. 2010 March; 37(1): 65–80.
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