The skin around the knee receives cutaneous innervation from multiple nerve branches: the infrapatellar branch of the saphenous nerve (medial and anterior), the anterior cutaneous branches of the femoral nerve (anterior thigh to knee), the lateral femoral cutaneous nerve (lateral knee), the common peroneal nerve lateral sural branch (lateral), and the medial sural cutaneous nerve (posterior). These branches are routinely damaged during knee arthroplasty incisions.
Lateral knee numbness after total knee arthroplasty (TKA) is universal from infrapatellar saphenous branch division; the extent of numbness depends on incision placement and is partially preventable by skin-sparing techniques. In patients with persistent neuropathic anterior knee pain after TKA, numbness mapping guides identification of the specific injured cutaneous branch and potential neuroma location. The saphenous infrapatellar branch is the primary target for specific neuroma treatment (injection, ablation) in post-TKA medial knee pain.
The standard medial parapatellar TKA incision divides the infrapatellar branch of the saphenous nerve producing permanent lateral knee numbness in 65-80% of patients; a transverse incision above the patellar tendon preserves more branches but limits surgical access; patients should be informed of expected lateral numbness before surgery.
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