Complex Regional Pain Syndrome after Total Knee Arthroplasty is Rare and Misdiagnosis Potentially Hazardous-Prospective Study of the New Diagnostic Criteria in 100 Patients with No Cases Identified.

2.50
Hdl Handle:
http://hdl.handle.net/11287/620600
Title:
Complex Regional Pain Syndrome after Total Knee Arthroplasty is Rare and Misdiagnosis Potentially Hazardous-Prospective Study of the New Diagnostic Criteria in 100 Patients with No Cases Identified.
Authors:
Kosy, Jonathan D.; Middleton, Simon W F; Bradley, Benjamin M; Stroud, Rowenna; Phillips, Jonathan R. A.; Toms, Andrew
Abstract:
Previous studies suggest that complex regional pain syndrome (CRPS) occurs in up to 21% of patients following total knee arthroplasty (TKA). However, this diagnosis has a substantial impact on the patient's management if it is incorrect. We aimed to identify cases, using updated internationally accepted criteria, while investigating potential causes of misdiagnosis.We prospectively studied a consecutive series of 100 primary TKA patients. Each patient was assessed 6-week post-TKA. Pain levels were recorded with the presence of symptoms and signs of CRPS (Budapest Diagnostic Criteria) assessed in those with excessive pain. An alternative diagnosis was sought, in these patients, including the presence of neuropathic pain.We found no cases of CRPS (no patients had symptoms or signs in greater than two of four subgroups). Seventeen patients had excessive pain levels (nine had an alternative diagnosis explaining this). The commonest signs were sensory and sudomotor, whereas motor/trophic changes were not seen. Using a previous definition (Orlando Criteria), eight patients may have been diagnosed with CRPS. Over half of the patients with unexplained excessive pain had evidence of neuropathic pain.CRPS is a rare diagnosis following TKA using modern criteria. Isolated signs and symptoms may lead to the overdiagnosis of CRPS in the presence of unexplained pain following TKA. New diagnostic criteria, with strict definitions and treatment algorithms, are now accepted. Delays in managing more common causes (such as neuropathic pain) may negatively affect the patient's outcome.
Citation:
Complex Regional Pain Syndrome after Total Knee Arthroplasty is Rare and Misdiagnosis Potentially Hazardous-Prospective Study of the New Diagnostic Criteria in 100 Patients with No Cases Identified. 2018 J Knee Surg
Publisher:
Thieme
Journal:
The journal of knee surgery
Issue Date:
2-Jan-2018
URI:
http://hdl.handle.net/11287/620600
DOI:
10.1055/s-0037-1615746
PubMed ID:
29294499
Additional Links:
http://www.thieme-connect.com/DOI/DOI?10.1055/s-0037-1615746
Type:
Journal Article
Language:
en
ISSN:
1938-2480
Appears in Collections:
Exeter Knee Reconstruction Unit (EKRU); 2018 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorKosy, Jonathan D.en
dc.contributor.authorMiddleton, Simon W Fen
dc.contributor.authorBradley, Benjamin Men
dc.contributor.authorStroud, Rowennaen
dc.contributor.authorPhillips, Jonathan R. A.en
dc.contributor.authorToms, Andrewen
dc.date.accessioned2018-01-25T12:03:47Z-
dc.date.available2018-01-25T12:03:47Z-
dc.date.issued2018-01-02-
dc.identifier.citationComplex Regional Pain Syndrome after Total Knee Arthroplasty is Rare and Misdiagnosis Potentially Hazardous-Prospective Study of the New Diagnostic Criteria in 100 Patients with No Cases Identified. 2018 J Knee Surgen
dc.identifier.issn1938-2480-
dc.identifier.pmid29294499-
dc.identifier.doi10.1055/s-0037-1615746-
dc.identifier.urihttp://hdl.handle.net/11287/620600-
dc.description.abstractPrevious studies suggest that complex regional pain syndrome (CRPS) occurs in up to 21% of patients following total knee arthroplasty (TKA). However, this diagnosis has a substantial impact on the patient's management if it is incorrect. We aimed to identify cases, using updated internationally accepted criteria, while investigating potential causes of misdiagnosis.We prospectively studied a consecutive series of 100 primary TKA patients. Each patient was assessed 6-week post-TKA. Pain levels were recorded with the presence of symptoms and signs of CRPS (Budapest Diagnostic Criteria) assessed in those with excessive pain. An alternative diagnosis was sought, in these patients, including the presence of neuropathic pain.We found no cases of CRPS (no patients had symptoms or signs in greater than two of four subgroups). Seventeen patients had excessive pain levels (nine had an alternative diagnosis explaining this). The commonest signs were sensory and sudomotor, whereas motor/trophic changes were not seen. Using a previous definition (Orlando Criteria), eight patients may have been diagnosed with CRPS. Over half of the patients with unexplained excessive pain had evidence of neuropathic pain.CRPS is a rare diagnosis following TKA using modern criteria. Isolated signs and symptoms may lead to the overdiagnosis of CRPS in the presence of unexplained pain following TKA. New diagnostic criteria, with strict definitions and treatment algorithms, are now accepted. Delays in managing more common causes (such as neuropathic pain) may negatively affect the patient's outcome.en
dc.language.isoenen
dc.publisherThiemeen
dc.relation.urlhttp://www.thieme-connect.com/DOI/DOI?10.1055/s-0037-1615746en
dc.rightsArchived with thanks to The journal of knee surgeryen
dc.subjectWessex Classification Subject Headings::Orthopaedicsen
dc.titleComplex Regional Pain Syndrome after Total Knee Arthroplasty is Rare and Misdiagnosis Potentially Hazardous-Prospective Study of the New Diagnostic Criteria in 100 Patients with No Cases Identified.en
dc.typeJournal Articleen
dc.identifier.journalThe journal of knee surgeryen
dc.type.versionIn press (epub ahead of print)en

Related articles on PubMed

All Items in RD&E Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.