[Chronic Pain After Knee Replacement Surgery] [Transarterial Microembolization (TAME)] Successful Case Sharing

A 61-year-old male, W, underwent total knee arthroplasty in his left knee more than 2 years ago, and still experiences knee pain post-surgery.

He has received medication, but the pain has not significantly improved, and the pain score is as high as 9 out of 10.

He was referred by National Cheng Kung University Hospital Orthopedics to the Interventional Medicine Center outpatient clinic for further discussion.

After discussion, Bow Wang, M.D. ultimately chose to perform "transarterial embolization for inflamed arteries" on male W. Guided by X-ray fluoroscopy, under local anesthesia, a microcatheter was inserted into the painful area via puncture of the femoral artery in the groin.

Under arterial angiography, contrast agent was injected to identify newly formed capillary-like vessels; then, embolic medication was injected through the microcatheter to remove these abnormal capillary-like vessels.

Knee Joint Arterial Angiography and Treatment

Two weeks after the embolization treatment, the patient's pain improved significantly.

However, Bow Wang, M.D. reminds patients that arterial embolization therapy for "chronic pain after knee replacement surgery" has its limitations. The main indication is a pain index exceeding 5 points, and patients who have not shown significant improvement after more than three months of various treatments.

This treatment is not suitable in the following situations:

1. Loosening of the artificial joint

2. Infection within the artificial joint

3. Pain accompanied by other nerve compression symptoms, such as numbness

4. Poor kidney function (eGFR < 30 mL/min/1.73m2)

5. Low platelet count, abnormal coagulation function

6. The patient is unable to lie flat for two hours

7. Pregnancy

Treatment side effects include possible local hematoma and bruising at the puncture site; temporary local discoloration at the embolization site, which will improve and disappear within a few days to a month.

It is recommended that patients undergo a detailed evaluation by a physician to confirm the true source of pain, and have a thorough discussion with their doctor and family to understand the treatment process and related precautions before receiving treatment for better assurance.