402 - From Wheelchair to Cane: Pain and Functional Gains With Peripheral Nerve Stimulation and Shockwave Therapy After Failed TKA

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

EC

Ekrem Cetinkaya, MS, DO

Resident Physician
Virginia Commonwealth University
Henrico, Virginia, United States

Co-Author(s)

MA

Motasem Abul-Huda, DO

Resident Physician
JFK Johnson Rehabilitation Institute
Lodi, New Jersey, United States
DT

Daniel Tsukanov, DO

PM&R Physician
Virginia Commonwealth University (VCU)
Richmond, Virginia, United States

Submitter(s)

EC

Ekrem H. Cetinkaya, DO

Jefferson Einstein Montgomery Hospital
Lansdale, Pennsylvania, United States

Case Diagnosis: Complex chronic pain and arthrofibrosis following total knee arthroplasty (TKA)

Case Description: A 72-year-old female veteran with bilateral TKAs (left 2009, right 2014 with three revisions and interim antibiotic spacer) presented to the Central Virginia Veterans Affairs clinic in 2014 with severe chronic right knee pain, arthrofibrosis, and ROM restrictions limiting her mobility to a motorized wheel chair. Over a 10 year period, multiple pain modulating interventions including nerve blocks, radiofrequency ablations, and hydrodissection attempts were used with minimal improvement. In October 2024, we placed an ultrasound-guided saphenous nerve peripheral stimulator (Bioness StimRouter). By the middle of 2025, her pain improved substantially (7/10→2–3/10). We also initiated shockwave therapy (SWT) to the right knee joint line and peripatellar region allowing her ROM to improve from 20-50°→ -10–60° flexion-extension. She no longer needs her motorized wheelchair and now uses only a single point cane for ambulation.

Discussions: With around 100,000-300,000 patients suffering annually from unresolved pain and arthrofibrosis post-TKA, this case demonstrates the efficacy and role of combining both the StimRouter and SWT to provide durable pain relief. Allowing significantly improved ambulation, ROM, and reduced analgesic reliance. SWT in particular has been essential as a significant adjunct to address capsular restriction and scar-related stiffness. This integration of targeted neuromodulation and SWT can be used as a multipoint approach to address post-TKA complications with neuropathic pain and arthrofibrosis.

Conclusions: In a patient with multiple failed TKA and revision surgeries, persistent neuropathic pain, and severe stiffness, the combination of a peripheral nerve stimulator and shockwave therapy provided meaningful improvements in pain, ambulation, and ROM. This case suggests that novel approaches like pairing implantable nerve stimulators with SWT may offer a lasting strategy for patients with otherwise limited post-arthroplasty outcomes.