Partial Knee Joint Denervation – Dellon Method
Chronic pain in the knee joint can sometimes persist even after exhausting all conservative and operative treatment methods. For patients suffering from this difficult problem, we can offer a less-well known treatment here in Germany. Professor A.L Dellon (Plastic Surgery and Neurosurgery, Baltimore, USA) developed an operation to treat knee pain and has been successfully performing this since 1992. Dr G. Fromberg learned it from Professor Dellon himself and has been performing it since 1995.
In this operation, small pain transmitting nerves around the knee joint are singled-out and parts of them removed so that they cannot grow back together and transmit pain again. The knee joint itself is left untouched because the nerves are located in the muscles and fat tissues. This means that any changes in bones, cartilage or ligaments that led to the pain in the first place still exist, therefore, in future the knee can still occasionally swell or an x-ray may provide evidence of further changes. However, a successful operation will reduce pain to a tolerable level or even completely eliminate it. The experience with this method since 1992 has been encouraging.
It is a common misconception that when a nerve is cut it leads to paralysis. There is nothing to worry about in a knee joint denervation since the nerves that are cut do not possess any muscle control functions. Therefore, mobility is unaffected or it is actually made even better, especially if the pain restricted movement before the operation. The sensation on the skin-surface is also generally unaffected with the exception of the occasional feeling of numbness around the operation scar or in the case where a nerve in a previous operation has grown into the scar.
Who can a knee joint denervation help?
A knee-joint denervation should be considered if knee pain persists after exhausting all common conservative and surgical measures. For many elderly patients with advanced osteoarthritis, the final option until now has been to suggest the implant of an artificial knee joint, which is an extensive operation and can be high risk for some patients. In contrast, a knee joint denervation is a relatively small operation which can also be reasonably expected for more fragile patients to undergo. In order to get an idea of the expected results of the operation, we recommend an initial consultation in which we will inform you in detail about the operation itself and do a test nerve block on the affected knee nerves. To do this, we find the painful nerve exit points through touch and we inject a small amount of local anaesthetic in this area. As a result – but unfortunately only temporarily – the function of this nerve will be nullified. The patient will then be able to determine when walking or climbing stairs to what extent the pain has reduced. It is only if the patient judges the test as positive beyond any doubt that we recommend carrying out the surgery.
Knee joint denervation procedure
Surgery is performed under spinal or general anaesthetic. After applying a tourniquet to the thigh, a small skin incision is made at the position of each affected nerve. The surgeon then uses a microsurgery magnifier to locate the nerve and remove a part of it. After stopping bleeding, the wounds are sutured in layers and an elastic bandage is applied. After surgery and after the anaesthetic has worn off, you can stand up and put full stress on your legs. The tendency to bruise differs from person to person. In the first weeks after surgery it is recommended to frequently elevate and cool the operated leg in order to prevent swelling and bruising. Skin sutures are removed after 10-14 days. Any symptoms associated with the operation itself can, depending on the patients tendency to bruising, last up to 4 weeks.