Vol 2-3 Commentary

Commentary: “An Imaging Overview of the Posterior Septum of the Knee and Trans-Septal Portal Procedure: Normal Anatomy, Indications, and Unique Imaging Considerations”

Jay Moran1, Mark D. Miller2, Michael J. Medvecky1*

1Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA

2Department of Orthopaedics, University of Virginia, Charlottesville, VA, USA

DOI: 10.29245/2767-5130/2021/3.1148 View / Download Pdf
Vol 2-3 Commentary

Commentary: Management of Refractory Pain After Total Joint Replacement

Jamie Heimroth1*, Max L. Willinger1, Nipun Sodhi1, Luke J. Garbarino1, Peter A. Gold1, Jonathan R. Danoff2, Sreevathsa Boraiah2

1Department of Orthopedic Surgery, Long Island Jewish Medical Center, Queens, NY, USA

2Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, NY, USA

Chronic refractory pain after total joint replacement is debilitating and a source of dissatisfaction for patients. The management of pain following total joint replacement varies during the acute postoperative period compared to the 3 months postoperative at which point the pain is considered chronic pain. Acute postoperative pain relief programs have seen promising results with multimodal pain control through the use of combinations of opioids, acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids and ketamine. The addition of regional blocks to the multimodal regimen has improved acute postoperative pain control following total joint replacements. On the other hand, chronic pain can be successfully managed with options including genicular nerve radioablation therapy (GN-RFA), neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), and peripheral subcutaneous field stimulation (PSFS). While there is still minimal data on chronic pain relief regimens, meta-analyses and case reports have demonstrated the effectiveness and promising outcomes. This paper aims to evaluate the current medications and treatment options for managing refractory pain following TJA.

DOI: 10.29245/2767-5130/2021/3.1143 View / Download Pdf