The Hidden Nerve Causing Pain After Knee Replacement? | Dr. Yudi Kerbel Explains

Added: 2026-06-05

[00:00:00]We always think geniculars.

[00:00:01]One nerve, that actually turns out is really the culprit for most of what's going on in certainly in painful total knees, but in a lot of global painful knee conditions. Post-traumatic, arthritic, all kinds of stuff. It's the infrapatellar branch of the saphenous nerve.

[00:00:20]We always talk about it with patients cuz we tell them you'll get your incision and lateral to the incision is going to be numb.

[00:00:26]>> Mhm.

[00:00:26]>> So, no big deal, don't worry about it.

[00:00:28]And there's all this new movement now with lateral incisions to try and avoid that and all that kind of stuff.

[00:00:33]What we don't realize is that I think what happens in a lot of cases post-TKA is that after we incise the nerve, it forms a painful neuroma right over that sort of pes anserine area. So, we call it pes anseritis and we're like, "Oh, it's flexion instability from anterior-posterior translation and that's the issue." So, we then ask, "Should we do a revision for flexion instability? Should we do a pes injection?"

[00:00:58]The bottom line is if you just calm the nerve down, all that stuff gets better.

[00:01:02]So, I'm more and more convinced the more of these I do that the infrapatellar branch of the saphenous nerve is the key to changing the way we think about failed total knees.

[00:01:11]>> Mhm.

[00:01:12]>> And probably some massive number of painful failed total knees, it's not actually the knee itself. It's not the thickness of this nerve that is the culprit.

[00:01:22]Because I have seen in my practice they have instant pain from the most difficult, the most hard to treat patients, the most slam dunk. They are the happiest people suddenly. I tell other surgeons, "Send me your unhappy knees. I will take them gladly."

[00:01:38]It doesn't We're not saying it's magic.

[00:01:39]Obviously, you have these online things, "Oh, it works. It's so perfect." We've all been through that with all the stuff we've done, whether it's TKA, whatever.

[00:01:45]But, it truly is a game-changer for many of these patients.

[00:01:50]>> Mhm.

[00:02:03]>> Mhm.