Diagnosis and management of neuropathic pain post-total knee replacement: A systematic review

Table 1 Summary of study designs for included studies

No.	Ref.	Year	Study type	Intervention	Control	Follow-up (months)	Outcome	Conclusion
1	Rienstra et al[18]	2021	RCT	Duloxetine peri-operative	Analgesics, NSAIDs but no neuropathic medication	12	Pain severity using KOOS pain scale and VAS, and neuropathic pain using PainDETECT at 6 weeks, 6 and 12 months after TKR	Perioperative treatment with Duloxetine did not influence chronic or neuropathic pain up to one year after TKR
2	Buvanendran et al[25]	2010	RCT	Pregabalin peri-operative	Placebo tablets	6	Pain severity using immediate post-operative NRS, and proportion with neuropathic pain using S-LANSS at 3 and 6 months	Perioperative pregabalin treatment significantly reduced the rate of neuropathic pain to 6 months
3	Albayrak et al[23]	2017	Retrospective comparative	DRG RF Ablation	Analgesics, NSAID, local treatments	8	Pain severity using VAS, and neuropathic pain using DN4 at 15 days, 1 month and 8 months after 14-day admission for treatment of chronic and neuropathic pain three years after TKR	Radiofrequency ablation of the DRG at L4 improved the proportion of patients with neuropathic pain
4	Kretzschmar[15]	2019	Observational	DRG RF stimulator	NA	36	Pain severity using VAS, in patients selected for neuropathic pain using PainDETECT	Radiofrequency stimulation of DRG at L3&4 improved neuropathic pain to 1 year and this was sustained to three years
5	Yang et al[22]	2022	Retrospective comparative	Neurectomy, interventional pain procedures	Unclear-assume Analgesics NSAIDs	2	Pain severity using VAS, did not use a neuropathic pain score, but selected based on clinical examination	Selective denervation improves neuropathic pain after TKR
6	Zhong et al[21]	2018	Retrospective comparative	Neurectomy	Analgesics, NSAID, local treatments	12	Pain severity using VAS, did not use a neuropathic pain score. Ruled out other causes of persistent post-operative knee pain	Selective denervation for those that show response to local injection improves neuropathic pain after knee surgery
7	Clendenen et al[20]	2015	Observational	Hydro-dissection of nerve	NA	9	Pain severity using VAS, did not use a neuropathic pain score. Selected patients based on clinical examination	Hydro-dissection with steroid and local anesthetic to potentially free a stuck nerve improved chronic medial knee pain after TKR

RCT: Randomized-controlled trials; DRG: Dorsal root ganglion; RF: Radiofrequency; RF: Radiofrequency; NSAID: Nonsteroidal anti-inflammatory drug; KOOS: Knee Injury and Osteoarthritis Outcome Score; S-LANSS: Self-reported Leeds Assessment of Neuropathic Symptoms and Signs; DN4: Douleur-Neuropathique-4; TKR: Total knee replacement; NRS: Numerical Rating Scale.