Pes anserinus pain syndrome following total knee arthroplasty for degenerative varus: incidence and predictors
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ORIGINAL PAPER
Pes anserinus pain syndrome following total knee arthroplasty for degenerative varus: incidence and predictors Abdulrahman D. Algarni 1 Received: 20 August 2019 / Accepted: 31 January 2020 # SICOT aisbl 2020
Abstract Purpose Pes anserinus pain syndrome (PAPS) is a well-described condition in the native knee; however, its incidence after total knee arthroplasty (TKA) is unknown. This study aimed to determine the incidence of PAPS after primary TKA, identify potential risk factors, and assess its response to treatment. Few case reports have been published until now; to our knowledge, ours is the first study assessing the incidence and predictors of post-TKA PAPS. Methods A total of 389 primary TKAs performed for degenerative varus knee at a single institution by the same surgeon were analyzed. We recorded demographic variables, medical comorbidities, and clinical, radiographic, and surgical data. Specific predictors of interest were compared between post-TKA PAPS and controls. Results The incidence was 5.6% (22/389). On univariate analysis, female sex (p = 0.03), body mass index (BMI) (41.3% ± 7.9; p < 0.001), and absence of pes anserinus release (p = 0.04) were significant predictors. On multivariable regression analysis, only BMI was a significant independent risk factor (p = 0.01). All patients were treated non-operatively; 81.8% responded to nonsteroidal anti-inflammatory drug–physical therapy program and 18.2% required an additional local steroid injection. Conclusion PAPS occurs after TKA; the incidence was found to be 5.6%. BMI seems to be an independent risk factor. It is a benign condition and can be effectively treated conservatively in most cases. Keywords Pes anserinus . Pain . Total knee arthroplasty
Introduction Pain following total knee arthroplasty (TKA) presents a diagnostic challenge. Studies have estimated that up to 20% of patients continue to experience pain following primary TKA [1]. Accurate diagnosis is crucial to determine the appropriate treatment and ensure a successful outcome. Performing a revision TKA without a definitive diagnosis is associated with a high rate of failure [2]. Pes anserinus pain syndrome (PAPS) is one of the possible extra-articular causes of painful TKA. PAPS is a collective term encompassing a host of different pathologies known to cause pain of the conjoined insertion. Moschcowitz first described this syndrome and its clinical symptoms in 1937 [3]. The distinction between pes anserinus (PA) bursitis and tendinitis is clinically difficult and not truly
* Abdulrahman D. Algarni [email protected] 1
Department of Orthopedic Surgery, King Saud University, Riyadh, Saudi Arabia
significant, as the treatment is the same for both conditions. To date, PAPS is a clinical diagnosis based on a history of medial knee pain characteristically worse on ascending or descending stairs and the presence of marked tenderness over the PA area on physical examination [4]. PAPS is known to occur in the knees of patients with degenerative osteoarthritis (OA), with a
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