Acute postoperative pain is an independent predictor of chronic postsurgical pain following total knee arthroplasty at 6 months: a prospective cohort study

Abstract

BackgroundApproximately 15% of patients report persistent knee pain despite surgical success following total knee arthroplasty (TKA). The purpose of this study was to determine the association of acute-postsurgical pain (APSP) with chronic postsurgical pain (CPSP) 6 months after TKA controlling for patient, surgical and psychological confounding factors.MethodsAdult patients with osteoarthritis undergoing primary elective tricompartmental TKA, with the operated knee the primary source of preoperative pain, were studied between March 2011 and February 2017. Patients received standard operative management and a perioperative multimodal analgesia regimen. The primary outcome was CPSP at 6 months. The primary variable of interest was the APSP (weighted mean pain score) for 72 hours postoperatively. Patient, surgical and psychological confounders were assessed using binary logistic regression.Results245 cases were analyzed. The incidence of CPSP was 14% (95% CI 10% to 19%). Median APSP values were 4.2 (2.2–5.0) in the CPSP group and 2.8 (1.8–3.7) without CPSP, difference 1.4 (95% CI 0.1 to 1.8, p=0.005). The unadjusted odds for CPSP with an increase of 1 in APSP was 1.46 (95% CI 1.14 to 1.87, p=0.002)). After multivariable risk adjustment, the OR for CPSP for an increase of 1 in the APSP was 1.53 (95% CI 1.12 to 2.09, p=0.008).ConclusionsAPSP is a risk factor for CPSP following TKA even after adjusting for confounding variables such as pain catastrophizing, anxiety, depression and functional status. Studies are needed to determine if APSP is a modifiable risk factor for the development of CPSP.

Midterm Outcomes of Ultrasound-guided Local Treatment for Infrapatellar Saphenous Neuroma Following Total Knee Arthroplasty

“…Delays or failure to recognize this entity can lead to long-term consequences. Buvanendran et al showed that acute postoperative pain is a predictor of patients transitioning to chronic pain [12]. They found that anxiety, pain catastrophizing, depression, and limited physical mobility were factors contributing to the development of chronic pain [12].…”

“…Buvanendran et al showed that acute postoperative pain is a predictor of patients transitioning to chronic pain [12]. They found that anxiety, pain catastrophizing, depression, and limited physical mobility were factors contributing to the development of chronic pain [12]. In a study of more than 30,000 patients, Lewis et al reported catastrophizing and preoperative pain as major factors for persistent postsurgical pain [13].…”

RNA expression preoperatively and postoperatively following total knee replacement: a pilot study in patients with and without chronic postsurgical pain

“…The results of the parent study have been reported separately 1. This manuscript adheres to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.…”

“…The Short-Form McGill Pain Questionnaire-2 was also administered 16. CPSP was defined as NRS pain with movement ≥4 at 6 months 1. To minimize false-positive assignment of CPSP based on a single NRS value, pain trajectories between 3 weeks and 6 months were evaluated, and a pattern of NRS pain at rest >0 and at least one prior recording of NRS pain during movement ≥4 were required to be classified as CPSP.…”

“…Chronic postsurgical pain (CPSP), with limited functional improvement despite objective surgical success, occurs in approximately 15% of patients following total knee arthroplasty (TKA) 1. Patients with CPSP also have decreased quality of life and are more likely to report dissatisfaction with TKA.…”