Associations between early postoperative pain outcome measures and late functional outcomes in patients after knee arthroplasty

Abstract

Introduction/Aim Early rehabilitation, return to daily life activities and function are the ultimate goals of perioperative care. It is unclear which pain-related patient-reported outcome measures (PROM) mirror treatment effects or are related with early and late functional outcomes. Methods We examined associations between two approaches of pain management (scheduled vs ‘on demand’) and PROMs on post-operative days one and five (POD1, 5) with function on POD5 and 3 months after surgery in patients undergoing Total Knee Arthroplasty (TKA) in a single centre. The scheduled pain management consisted of pain assessment and routine administration of non-opioid drugs, and a weak opioid based on severity of pain reported by patients. The ‘on demand’ group received non-opioids and/or a weak opioid only when asking ‘on demand’ for analgesics. Results On POD1, patients in the scheduled treatment group reported reduced severity of worst pain, less interference of pain with activities in-bed and sleep, and a higher proportion got out of bed. On POD5, these patients reported as well significantly less worst pain, spent significantly less time in severe pain, experienced less interference of pain with activities in bed, and felt less helpless. Furthermore, tests of function, extension and flexion ranges, Barthel index and 6 minutes walking test on POD5, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) 3 months later were significantly better in the scheduled treatment group compared to the ‘on demand’ treatment group. Pain related PROMs assessed at POD1 and especially at POD5 are associated with better knee range of motion, better performance in activities of daily living, and faster gait speed, as well as less pain, better performance in activities of daily living, as well as higher knee-related quality of life 3 months postoperatively. Conclusions Our study demonstrates that severe postoperative pain after TKA might have long lasting consequences, and even small improvements in treatment, although being far from optimal, are accompanied by improved outcomes.

A 1-Week Comprehensive Foam Rolling Intervention Program Can Improve Knee Pain but Not Muscle Function and Range of Motion in Patients with Total Knee Arthroplasty

“…In general, knee pain is known to occur after TKA, and Seo et al reported that 60% of patients who underwent TKA experienced severe postoperative knee pain, whereas 30% experienced moderate pain [ 22 ]. Also, the previous study investigated the association between pain on postoperative days one and five and motor function at three months, and the results showed that the less pain in the early postoperative period, the better the motor function at three months postoperatively [ 23 ]. It is also well-known that pain in the early postoperative period is associated with improved knee joint ROM, pain, and walking speed three months after TKA.…”

“…It is also well-known that pain in the early postoperative period is associated with improved knee joint ROM, pain, and walking speed three months after TKA. Therefore, improving physiotherapeutic interventions to decrease pain in the early postoperative period is necessary to control for improving knee joint ROM and walking functions [ 23 ]. The results of this study showed that one week of FR intervention on the anterior thigh from the second postoperative week resulted in a significant ( p = 0.031) reduction in pain score at stretching (−26.0 ± 1.4) as compared with the control group (−12.5 ± 1.9).…”

“…Early postoperative pain after TKA has been linked to persistent knee pain and reduced walking speed three months post-surgery, suggesting the importance of effective early pain control. Previous research has also found that the severity of pain on postoperative days one and five is associated with improved motor function at three months post-surgery [ 23 ]. FR intervention can be performed by patients and is therefore considered an effective tool for self-care during future rehabilitation.…”

Effect of continuous anesthetic wound infusion on postoperative activity in patients who underwent midline laparotomy for gynecological diseases

“…Similarly, postoperative pain relief in hip fracture patients was shown to promote early functional gait recovery [10]. Such a positive correlation was also seen in patients undergoing knee arthroplasty, where postoperative pain management was associated with better range of motion, better performance in daily activities, and faster gait speed [11].…”

The duration of postoperative analgesic use after total knee arthroplasty and nomogram for predicting prolonged analgesic use

“…Although total knee arthroplasty (TKA) is currently a reliable treatment for end-stage osteoarthritis patients with pain and disability, 11% to 18% of postoperative patients are dissatisfied with the procedure (2,3). Chronic postsurgical pain (CPSP), defined as pain lasting for more than three months after surgery, is regarded as a critical factor of postoperative dissatisfaction (3)(4)(5). Although CPSP has attracted much attention in the academic community, prolonged analgesic use (PAU), which often accompanies CPSP, has rarely been studied.…”