Aree Tanavalee1, Arak Limtrakul2, Pathomporn Veerasethsiri3, Chavarin Amarase1, Srihatach Ngarmukos1. 1. Faculty of Medicine, Department of Orthopaedics, Chulalongkorn University, Bangkok, Thailand. 2. Department of Orthopedic Surgery, Taksin Hospital, Bangkok, Thailand. 3. Department of Orthopedic Surgery, Ratchaburi Hospital, Ratchaburi, Thailand.
Abstract
BACKGROUND: Skin numbness after total knee arthroplasty (TKA) was reported in relation to injury of the infrapatellar branch of saphenous nerve (IPBSN). METHODS: Phase I study: A nonrandomized and nonconsecutive selection of 30 patients undergoing unilateral TKA, using minimally invasive surgery approach, and 30 patients having standard approach were included. Area of skin numbness was periodically evaluated and compared until 1-year follow-up (FU). Phase II study: we dissected 15 normal cadaveric knees and followed the course and distribution of IPBSN. RESULTS: Twenty-nine predominantly female patients in each group completed 1-year FU with no differences in demographic data. Both the groups had significantly improved Knee Society Score clinical and function scores with no statistical differences. The numb areas in both the groups similarly decreased from 2 weeks (51.7 cm2 vs 51.1 cm2) to 1 year (2.1 cm2 vs 2.4 cm2) with similar percentages of no skin numbness at 1 year (69% vs 65%). The IPBSN branched from saphenous nerve before exiting the adductor canal and ran longitudinally and obliquely. It was found as a single nerve in 20%, a 2-branch nerve in 67% and a 3-branch nerve in 13%. All branches crossed the knee midline between superior patellar pole and tibial tubercle. CONCLUSION: Clinical study showed that TKA using minimally invasive surgery approach provided similar area of skin numbness to standard approach. Numbness area gradually decreased at serial FUs in both the groups. The cadaveric study demonstrated that the IPBSN consistently gave no branch passing the knee midline above superior patellar pole.
BACKGROUND:Skin numbness after total knee arthroplasty (TKA) was reported in relation to injury of the infrapatellar branch of saphenous nerve (IPBSN). METHODS: Phase I study: A nonrandomized and nonconsecutive selection of 30 patients undergoing unilateral TKA, using minimally invasive surgery approach, and 30 patients having standard approach were included. Area of skin numbness was periodically evaluated and compared until 1-year follow-up (FU). Phase II study: we dissected 15 normal cadaveric knees and followed the course and distribution of IPBSN. RESULTS: Twenty-nine predominantly female patients in each group completed 1-year FU with no differences in demographic data. Both the groups had significantly improved Knee Society Score clinical and function scores with no statistical differences. The numb areas in both the groups similarly decreased from 2 weeks (51.7 cm2 vs 51.1 cm2) to 1 year (2.1 cm2 vs 2.4 cm2) with similar percentages of no skin numbness at 1 year (69% vs 65%). The IPBSN branched from saphenous nerve before exiting the adductor canal and ran longitudinally and obliquely. It was found as a single nerve in 20%, a 2-branch nerve in 67% and a 3-branch nerve in 13%. All branches crossed the knee midline between superior patellar pole and tibial tubercle. CONCLUSION: Clinical study showed that TKA using minimally invasive surgery approach provided similar area of skin numbness to standard approach. Numbness area gradually decreased at serial FUs in both the groups. The cadaveric study demonstrated that the IPBSN consistently gave no branch passing the knee midline above superior patellar pole.
Authors: Sung R Lee; Nicholas J P Dahlgren; Jackson R Staggers; Cesar de Cesar Netto; Amit Agarwal; Ashish Shah; Sameer Naranje Journal: J Clin Orthop Trauma Date: 2018-03-09
Authors: Georg Riegler; Christopher Pivec; Suren Jengojan; Johannes A Mayer; Christoph Schellen; Siegfried Trattnig; Gerd Bodner Journal: Clin Anat Date: 2020-02-29 Impact factor: 2.414