Spinal Cord Stimulation For The Treatment Of Chronic Knee And Leg Pain Following Total Knee Replacement Complicated By Arterial Injury
Alexander Yakovlev, MD; Alexander Timchenko, MD; Angela M. Parmentier, APNP
INTRODUCTION: 51-year-old gentleman underwent total left knee replacement because of severe osteoarthritis. The procedure was complicated by an injury to the popliteal artery, requiring repair by a vascular surgeon. Despite early intervention patient reported pain around left knee, coldness in his foot, and paraesthesia throughout his left calf.
METHODS: Patient was referred for evaluation after a 1-year history of chronic left knee pain, coldness in the foot, swelling to the lower extremity, and paresethia of the calf. No further surgical intervention was recommended by the vascular or orthopedic surgeon. Initially sympathetic nerve blocks were performed, and after minimal response a SCS trial was performed. Two octad leads were placed in the posterior epidural space at the level of T8, T9, and T10.
RESULTS: SCS trial significantly alleviated the patient’s pain by 95%. Patient also reported a decrease in swelling and a feeling of warmth to the extremity. Patient proceeded with permanent implantation of SCS. At three month follow up visit, patient reports use of stimulator 24 hours a day and adjusts stimulation as pain intensity varies.
CONCLUSIONS: Spinal cord stimulation may benefit patients with debilitating and intractable knee pain despite a total knee replacement. It has been shown to improve arterial insufficiency.
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