ORTHOpress, 10/2009
There are always patients in whom it is not possible to get chronic knee pain under control sufficiently to allow a tolerable life. Yet as far back as 1992, Professor A. Lee Dellon from Baltimore introduced a gentle surgical procedure that has since been successfully applied many times in the USA, with which pain can be eliminated without opening the knee joint.
Dr. Schuhmann, what operation are we talking about?
Dr. Schuhmann: We are talking here about what is known as knee joint denervation, i.e. the targeted severing of the nerve fibres that transmit pain signals from the knee to the brain. To be clear, this is not a causal therapy, meaning the pain-causing changes to cartilage, bone or ligaments are not healed. However, the associated pain is eliminated and patients can participate in life again with a completely new quality of life.
Isn't such a nerve severance associated with paralysis and sensory disturbances?
Dr. Schuhmann: That is not to be feared, because the pain-conducting nerve fibres do not have these functions at all. On the contrary: mobility often even improves, because the knee is usually not moved properly due to pain. This inhibition is now eliminated. The sensitivity of the skin is also usually preserved, apart from a certain numbness that sometimes occurs around the small surgical scars.
How does such a procedure work?
Dr. Schuhmann: During the operation, the pain-conducting nerves around the knee joint are located through a small incision and severed. More precisely, a small piece of nerve is cut out so that the ends cannot grow back together. This permanently eliminates the sensation of pain. The advantage is that the knee joint itself does not need to be opened for this. The burden on patients is therefore very low. The procedure takes about 30 to 40 minutes and is performed during a short inpatient stay. It carries very low risk and is well tolerated even by older patients.
Which patients are suitable for knee joint denervation?
Dr. Schuhmann: In principle, for all patients with chronic knee pain in whom other measures are not sufficiently effective or are not possible. Whether the procedure promises success for a particular patient can even be tested beforehand. For this purpose, the corresponding nerve exit points are injected with a local anaesthetic. If patients respond to this and the pain subsides, the operation promises to be successful. However, I would like to point out once again that this procedure does not represent a cure, but does provide sometimes dramatic pain relief. Here in Hattingen we have already been able to achieve excellent results with this minimally invasive knee joint denervation.
Dr. Schuhmann, thank you very much for the interesting conversation!
