Assessment of Chronic Postsurgical Pain After Knee Replacement: A Systematic Review

Abstract

ObjectiveApproximately 20% of patients experience chronic pain after total knee replacement (TKR), yet there is no consensus about how best to assess such pain. This systematic review aimed to identify measures used to characterize chronic pain after TKR.MethodsMEDLINE, Embase, PsycINFO, Cochrane Library, and CINAHL databases were searched for research articles published in all languages from January 2002 to November 2011. Articles were eligible for inclusion if they assessed knee pain at a minimum of 3 months after TKR, yielding a total of 1,164 articles. The data extracted included the study design, country, timings of assessments, and outcome measures containing pain items. The outcome measures were compared with domains recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) for inclusion in the assessment of chronic pain–related outcomes within clinical trials. Temporal trends were also explored.ResultsThe review found use of a wide variety of composite and single-item measures, with the American Knee Society Score the most common. Many measures used in published studies did not capture the multidimensional nature of pain recommended by the IMMPACT; of those commonly used, the Western Ontario and McMaster Universities Osteoarthritis Index and Oxford Knee Score were the most comprehensive. Geographic trends were evident, with nation-specific preferences for particular measures. A recent reduction in the use of some clinically administered tools was accompanied by an increased use of patient-reported outcome measures.ConclusionThere was wide variation in the methods of pain assessment alongside nation-specific preferences and changing temporal trends in pain assessment after TKR. Standardization and improvements in assessment are needed to enhance the quality of research and facilitate the establishment of a core outcome set.

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

“…95 While WOMAC and other disease-and joint-specific PROMs can be used to describe the pattern of recovery after joint replacement, 48 their sensitivity to change is affected by floor and ceiling effects. At 12 months after knee replacement, Roos and Toksvig-Larsen 306 reported ceiling effects in 11% of patients for WOMAC function and 30% for WOMAC pain.…”

The natural history of pain and neuropathic pain after knee replacement

“…Most studies on pain focus on the early post-operative period with few continuing beyond three months after TKR. [19][20][21] We therefore designed a prospective study involving a cohort of patients undergoing TKR for osteoarthritis evaluating pain and any neuropathic element to it, at regular intervals, for a minimum of three years post-operatively. The primary aim was to establish the prevalence of pain at specific intervals post-operatively, and to ascertain the impact of neuropathic pain.…”

Challenges in postdischarge function and recovery: the case of fast-track hip and knee arthroplasty

“…Moderate to severe pain occurs in 30-40% of patients 2 weeks after surgery, 26 27 with a well-documented transition to persistent pain in 15% after TKA and 5% after THA, 28 and an overall increased analgesic consumption 1 yr after surgery in 47% of TKA patients, 9 challenging the consensus of pain relief after lower limb arthroplasty. Before surgery, knee osteoarthritis patients have decreased pressure pain thresholds (hyperalgesia) 29 and thermal hyperalgesia, which overall is decreased after 1 month 29 but persists in a subgroup of patients with persistent postoperative TKA pain.…”