Abstract
Background
Unexplained pain is one of the most common complications after Oxford UKAs. We have retrospectively reviewed the patients who underwent Oxford UKAs and investigated those patients with prolonged pain and found that many of these patients had strong tenderness over the Hunter canal and they were well treated with Hunter canal block or administration of Pregabalin. We have checked the details of these prolonged pain and key to the treatment will be discussed.
Methods
Between May 2006 and September 2014 we have performed 316 Oxford UKAs. There were 47 males and 269 females with average age of 70.4 years old (46–90). The patients were followed up for at least 6 months (6 months to 8.0 years, mean follow-up period of 3.1 years). The patients were examined both clinically and radiologically.
Result
There were 30 knees (9.5%) that showed prolonged pain continuing more than 3 month after the operation(Fig.1). Of these 30 knees, 17 knees had strong tenderness over the Hunter canal, and many patients had numbness and radiating pain toward medial side of the lower extremities. They were diagnosed as having Hunter canal syndrome clinically. Of these 17 knees 5 were treated successfully with Hunter canal block with Lidocaine. Remaining 12 knees were treated with Pregabalin or with Tramadol. All but 1 knee, pain disappeared within 3 months after starting the treatment as we stated. There were 3 cases that were finally diagnosed as having lumbar canal stenosis and L3 root block was effective. For the 10 knees not diagnosed as having Hunter canal syndrome without any tenderness over the Hunter canal, the pain disappeared spontaneously in 2 knees, and the pain disappeared with administration of Pregabalin or Tramadol in 6 knees. Two patients didn't respond to any treatment, they were referred to psychiatrist and diagnosed as having mental problems. There was no abnormal radiolucency, which suggested loosening of the component. As a result, true unexplained pain that continued more than a year was only 1.
Discussion
17 knees out of 30 unexplained pain knees after Oxford UKAs had strong tenderness over the Hunter canal, and the pain disappeared after the saphenous nerve block or adminestration of Pregabalin except for 1 knee. Patients without the diagnosis of Hunter canal syndrome also responded well to either Pregabalin or Tramadol. The pain continuing for more than 3 months after Oxford UKA is usually self-limited and well treated conservatively. With these results, when you see the prolonged pain after Oxford UKA, we strongly recommend just wait and see by conservative treatment with Pregabalin, Tramadol or saphenous nerve block, and do not revise the implant.
