A Randomized, Controlled Trial of Total Knee Replacement

Skou, Søren Thorgaard; Roos, Ewa M.; Laursen, Mogens Berg; Rathleff, Michael Skovdal; Arendt-Nielsen, Lars; Simonsen, Ole; Rasmussen, Sten

doi:10.1056/nejmoa1505467

Cited by 575 publications

(482 citation statements)

References 34 publications

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“…Along this line OA patients with chronic pain after knee replacement continue to have impaired descending control (Skou et al, 2013). Exercise is known to be advantageous in OA for pain management (Skou et al, 2015), and some of this pain alleviation may be caused by a positive effect on CPM (Courtney et al, 2016).…”

Section: Descending Pain Controlmentioning

confidence: 99%

Assessment and manifestation of central sensitisation across different chronic pain conditions

Arendt-Nielsen

Morlion

Perrot

et al. 2017

European Journal of Pain

517

494

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Different neuroplastic processes can occur along the nociceptive pathways and may be important in the transition from acute to chronic pain and for diagnosis and development of optimal management strategies. The neuroplastic processes may result in gain (sensitisation) or loss (desensitisation) of function in relation to the incoming nociceptive signals. Such processes play important roles in chronic pain, and although the clinical manifestations differ across condition processes, they share some common mechanistic features. The fundamental understanding and quantitative assessment of particularly some of the central sensitisation mechanisms can be translated from preclinical studies into the clinic. The clinical perspectives are implementation of such novel information into diagnostics, mechanistic phenotyping, prevention, personalised treatment, and drug development. The aims of this paper are to introduce and discuss (1) some common fundamental central pain mechanisms, (2) how they may translate into the clinical signs and symptoms across different chronic pain conditions, (3) how to evaluate gain and loss of function using quantitative pain assessment tools, and (4) the implications for optimising prevention and management of pain. The chronic pain conditions selected for the paper are neuropathic pain in general, musculoskeletal pain (chronic low back pain and osteoarthritic pain in particular), and visceral pain (irritable bowel syndrome in particular). The translational mechanisms addressed are local and widespread sensitisation, central summation, and descending pain modulation. Significance Central sensitisation is an important manifestation involved in many different chronic pain conditions. Central sensitisation can be different to assess and evaluate as the manifestations vary from pain condition to pain condition. Understanding central sensitisation may promote better profiling and diagnosis of pain patients and development of new regimes for mechanism based therapy. Some of the mechanisms underlying central sensitisation can be translated from animals to humans providing new options in development of therapies and profiling drugs under development.

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Section: Descending Pain Controlmentioning

confidence: 99%

Assessment and manifestation of central sensitisation across different chronic pain conditions

Arendt-Nielsen

Morlion

Perrot

et al. 2017

European Journal of Pain

517

494

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“…It is well accepted that any exercise performed and monitored regularly will improve physical function and pain in people with knee OA. 17,38 Unknown are the optimal dose and type of exercise that would maximize outcomes over sustained periods. There are few studies that have evaluated targeted hip strengthening in knee OA as a management strategy 45 ; consequently, evidence to guide clinical decisions with regard to this is incomplete.…”

Section: Measure/studymentioning

confidence: 99%

“…19,42 An aging population and the elevated costs and adverse events associated with end-stage OA-related joint replacement surgery have contributed to the escalating global and economic burden of the disease. 11,24,38 Research has therefore sought to optimize conservative interventions to reduce pain, improve physical function, and potentially delay disease progression. 17 A recent Cochrane review established high-quality evidence that lower-limb rehabilitation exercise can improve pain and physical function in people with knee OA.…”

mentioning

confidence: 99%

Hip Strength Deficits in People With Symptomatic Knee Osteoarthritis: A Systematic Review With Meta-analysis

Deasy¹,

Leahy²,

Semciw³

2016

Journal of Orthopaedic & Sports Physical Therapy

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Standardized mean differences (SMDs; Hedges' g) were calculated from means and standard deviations (mean difference/pooled SD) of muscle strength data using Review Manager software (Version 5.2; The Cochrane Collaboration, London, UK). The SMDs of 0.2, 0.5, and 0.8 were considered small, moderate, and large, respectively. 9 The percentage difference in strength was also calculated to provide a further indication of the relative difference in strength between OA and control participants [(OA strength -control strength)/control strength × 100]. Results were grouped according to the type of strength measurement (eg, isometric or isokinetic) or hip action performed (eg, hip flexion or extension). Data were pooled for multiple studies in a meta-analysis within each group using a random-effects model. When studies reported on multiple grades of OA classification (eg, Kellgren-Lawrence grade 2 or 3) without reporting on muscle strength of the whole sample combined, only the more established OA grading was used in the meta-analysis, to avoid repeated assessment of control-group data. When studies measured isokinetic strength at multiple speeds, the slower speed was used, as slower speeds are considered more reliable.35,41 When a study reported results of left and right knees of participants with bilateral knee OA, only the side with the most conservative SMD was presented, to avoid repeated inclusion of control-group data.10 Statistical heterogeneity across pooled studies was assessed using the I 2 statistic, in which a value of 25%, 50%, or 75% was considered a low, moderate, or high level of heterogeneity, respectively. 23 Assessment of Quality of Body of EvidenceA modified version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence in each meta-analysis. 20,35,43 The GRADE tool has been modified to apply to observational, nonexperimental data. 35,43 Each meta-analysis was graded using the following predefined criteria: (1) inconsistency (downgraded if I 2 was 50% or greater), (2) Screened by title and abstract, n = 1737Screened by title and abstract, n = 1737Full-text articles assessed for eligibility, n = 102Full-text articles assessed for eligibility, n = 102Hip strength in knee OA compared to control, n = 5Hip strength in knee OA compared to control, n = 5Hip strength as a risk factor for knee OA development, n = 0Hip strength as a risk factor for knee OA development, n = 0

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“…TKA is considered to be one of the most effective procedures in orthopaedic surgery, relieving the suffering of millions of people with arthritis and improving their quality of life [11,27]. Despite the documented benefits of TKA, racial and ethnic disparities have been reported in the utilization of TKA in the United States [2,4].…”

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Above-knee Amputations After TKA: A National Database Study

George

Navale

Schiltz

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Above-knee amputation (AKA) is a rare but devastating complication of TKA. Although racial disparities have been previously reported in the utilization of TKA, it is unclear whether disparities exist in the rates of AKA after TKA. Questions/purposes (1) Which gender-racial group has the highest rate of AKA from septic and aseptic complications of TKA? (2) Which age groups have higher rates of AKA from septic and aseptic complications of TKA? Methods Using National Inpatient Sample data from 2000 to 2011, AKAs resulting from complications of TKA were identified using a combination of International Classification of Diseases, 9th Revision procedure and diagnosis codes. Of the 341,954 AKAs identified, 9733 AKAs were the result of complications of TKA (septic complications = 8104, aseptic complications = 1629). Standardized AKA rates were calculated for different age and gender-racial groups by dividing the number of AKAs in each group with the corresponding number of TKAs. Standardized rate ratios were calculated after adjusting for demographics and comorbidities. Results After adjusting for age and comorbidities, black men had the highest rate of AKA after TKA (adjusted rate in black men = 578 AKAs per 100,000 TKAs, standardized rate ratio [SRR] = 4.32 [confidence interval {CI},.82], p \ 0.001). Black men also had the highest rate of AKA after septic complications of TKA (p \ 0.001). The adjusted rates of AKA were higher in patients younger than 50 years (adjusted rate = 473, SRR = 3.14 [CI, 2.94-3.36], p \ 0.001) and older than 80 years (adjusted rate = 297, SRR = 1.85 [CI, 1.76-1.95], p \ 0.001). Conclusions The rising demand for TKA has led to an increase in the number of AKAs performed for complications of TKA in the United States. Although we did not find an increase in the rate of AKA during the study period, certain populations, including black men and patients older than 80 years and younger than 50 years, had higher rates of AKA. Further studies are required to understand the reasons for these disparities and measures should be undertaken to eliminate these disparities. Level of Evidence Level III, therapeutic study.

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A Randomized, Controlled Trial of Total Knee Replacement

Cited by 575 publications

References 34 publications

Assessment and manifestation of central sensitisation across different chronic pain conditions

Assessment and manifestation of central sensitisation across different chronic pain conditions

Hip Strength Deficits in People With Symptomatic Knee Osteoarthritis: A Systematic Review With Meta-analysis

Racial Disparities in Above-knee Amputations After TKA: A National Database Study

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