SA Orthopaedic Journal
On-line version ISSN 2309-8309
GARRETT, BR and WALTERS, J. Knee pain, swelling and stiffness after total knee replacement: a survey of South African knee surgeons. SA orthop. j. [online]. 2010, vol.9, n.2, pp. 59-66. ISSN 2309-8309.
Knee pain, swelling and stiffness after total knee replacement (TKR) surgery are well-recognised complications. However, in some cases, despite investigation, the cause may be unexplained. This study, using a questionnaire sent to South African orthopaedic surgeons, examined the perceived incidence of unexpected knee pain and swelling after a straightforward TKR, aiming to identify possible associated or contributory factors. Of the 61 respondents, two-thirds had more than 10 years' experience and close to three-quarters performed 20 or more TKRs per annum. Less-experienced surgeons report a greater frequency of unexpected pain than more-experienced surgeons (90% vs 53%) (p<0.05). Similarly, surgeons using the visual analogue scale (VAS) to assess a patient's pain also have a greater awareness of unexpected pain. Two-thirds of surgeons reported finding more pain than had been anticipated in between 6% and 20% of their cases. Unexpected swelling is also an issue. Approximately one-half of surgeons could identify the cause for pain in less than 5% of their cases. Surgeons who use drains and have shorter surgical times reported a reduced incidence of unexpected pain and swelling, although this did not reach statistical significance. No suggestive relationships were found for other peri-operative parameters such as analgesic regimens, thrombo-embolic prophylaxis or mobilisation protocols.