D137. Surgical Management Algorithm for Peripheral Nerve Symptoms Following Total Knee Arthroplasty

PURPOSE: Neuropathic pain, weakness, or numbness can complicate total knee arthroplasty (TKA) and may be resistant to non-surgical treatments. This study evaluates surgical peripheral nerve management after TKA and a treatment algorithm is proposed. METHODS: Patients who underwent peripheral nerve surgery for neuropathic symptoms following TKA between 2012-2024 (≥3-month follow-up) were included. Data on demographics, comorbidities, and treatment were collected, and a cross-sectional survey assessed satisfaction (Patient Global Impression of Change, PGIC) and quality of life (EuroQol-5-Dimension-5-Level, EQ-5D-5L). RESULTS: Twenty-seven lower extremities treated in 26 patients were included (median age-at-surgery 67(IQR: 58-71.8) years). Surgical indications included neuropathic pain (n=24/27, 89%), foot drop (n=1/27, 4%) or both (n=2/27, 7%). Median time between TKA and nerve surgery was 2.5(IQR: 1.0-5.9) years. Procedures included saphenous or infrapatellar branch neurectomy with adjunctive nerve management (48%, n=13), decompression (41%, n=11), and combinations (11%, n=3). Twenty-one patients (78%) completed the survey (median follow-up 2.1(IQR: 1.4-4.3 years). Improvement (PGIC) was reported in 20/21(95%) patients, the mean EQ-5D-5L index was 0.854(±0.102) (US general population: 0.851(±0.205)). CONCLUSION: Surgery appears beneficial for patients with neuropathic pain, numbness, or weakness post-TKA. We recommend common peroneal nerve decompression for lateral knee pain and/or foot drop, active saphenous nerve management (targeted muscle reinnervation or regenerative peripheral nerve interface) for medial knee pain, and combinations for both. These findings may aid in patient counseling, expectation management, and surgical management.