Centrally sensitized patients undergoing total knee arthroplasty have higher expectations than do non-centrally sensitized patients

Abstract

Purpose The goal of this retrospective observational study is to determine whether patients with and without central sensitization (CS) undergoing total knee arthroplasty (TKA) have similar preoperative expectations. It was hypothesized that the degree of preoperative expectations is higher in patients with CS than in those without. Methods The data of 324 patients who underwent primary unilateral TKA for knee osteoarthritis were reviewed and CS was measured using the Central Sensitization Inventory (CSI), which is a validated self-reported questionnaire consisting of a total of 25 questions. CS was deined as a CSI score of 40 or more. Patient expectations were investigated using the Hospital for Special Surgery Knee Replacement Expectations Survey (HSS-KRES) comprising ive categories including pain relief, baseline activity, high lexion activity, social activity, and psychological well-being. The expectations of patients, the Western Ontario and McMaster Universities arthritis index (WOMAC) and American Society of Anesthesiologists (ASA) classiication scores were compared between the CS and non-CS groups. ResultsThe top three patient expectations in both groups were pain relief, psychological well-being, and walking ability. The total score for the expectations was 55.0 ± 8.3 in the CS group and 52.3 ± 10.4 in the non-CS group, indicating that the expectations of the CS group were higher than the non-CS group before TKA (p < 0.05). When the items on the HSS-KRES scale and the ive categories were compared, the CS group had signiicantly higher expectations for pain relief and psychological well-being than did the non-CS group (all p < 0.05). ConclusionThe expectations of patients with CS before TKA were higher than those without CS. Given the limited improvement in patient-reported outcome measures of patients with CS undergoing TKA, they should be counseled to be realistic especially with their preoperative expectations of pain relief and psychological well-being. Level of evidence III.

Central Sensitization and Neuropathic Pain Cumulatively Affect Patients Reporting Inferior Outcomes Following Total Knee Arthroplasty

“…In the present study, the prevalences of central sensitization and neuropathic pain were 38.9% and 28.5%, respectively. These results are similar to those in previous studies 11,13,[16][17][18][19][20][21] . The pain pattern of OA is generally in the form of nociceptive pain 38 .…”

“…Central sensitization occurs in association with a variety of underlying mechanisms, including sensitization within the spinal cord and signal amplification secondary to active descending pain- promoting pathways 37 . Central sensitization is characterized by allodynia and hyperalgesia and is generally reported in about 20% to 40% of patients with knee OA [16][17][18][19][20][21] . The prevalence of neuropathic pain has been reported to range from 14% to 35%, and, on average, it is reported to be 23% in patients with knee OA 11,[13][14][15] .…”

Preoperative education on realistic expectations improves the satisfaction of patients with central sensitization after total knee arthroplasty: a randomized‐controlled trial

“…Wound complication was reported to occur more often in patients with high CSI scores [34]. Patients with high CSI scores are also generally known to have high preoperative expectations [14]. In our study, it seems that patients with high CSI scores were able to change high expectations into realistic expectations through realistic expectation education before TKA surgery.…”

“…Central sensitization, identified using the Central Sensitization Inventory (CSI), has been associated with more severe and persistent pain following TKA, which is a strong predictor of patient dissatisfaction [12, 13]. Furthermore, centrally sensitized patients were found to have higher preoperative expectations and limited improvement in patient‐reported outcome measures than non‐centrally sensitized patients [14]. Thus, these patients should be managed differently and could potentially benefit from expectation management [11].…”

Combinations of Preoperative Patient-Reported Outcome Measure Phenotype (Pain, Function, and Mental Health) Predict Outcome After Total Knee Arthroplasty

“…Identifying patients at risk of dissatisfaction following TKA is important to help set patient satisfactions and stratify risk. Fulfillment of preoperative expectations has been established as an important factor associated with favorable patient outcomes after surgery [50,51]. Patients identified as at-risk for dissatisfaction using the preoperative combined PROM phenotypes can be counseled on expectations.…”