Clinical Course of Pain and Function Following Total Knee Arthroplasty: A Systematic Review and Meta-Regression

Sayah, Said Mohamad; Karunaratne, Sascha; Beckenkamp, Paula R.; Horsley, Mark; Hancock, Mark J.; Hunter, David J.; Herbert, Robert D.; Campos, Tarcisio F de; Steffens, Daniel

doi:10.1016/j.arth.2021.06.019

Cited by 38 publications

(25 citation statements)

References 209 publications

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“…Our findings are in consistency with other reviews and meta-analysis [13,18]. There is emerging evidence that improvement in pain for most patients usually follows a steep trajectory in the first three to six postoperative months, before pain levels seems to plateau at twelve months [73][74][75]. Accordingly, we have added new evidence on preoperative factors correlated with adverse pain outcomes at three, six and twelve months after TKA.…”

Section: Plos Onesupporting

confidence: 90%

Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis

et al. 2023

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Main objective Systematically review and synthesize preoperative and intraoperative factors associated with pain after total knee arthroplasty (TKA) in patients with osteoarthritis. Methods Based on a peer-reviewed protocol, we searched Medline, Embase, CINAHL, Cochrane Library, and PEDro for prospective observational studies (January 2000 to February 2023) investigating factors associated with pain after TKA. The primary outcome was pain twelve months after TKA. Pain at three and six months were secondary outcomes. Multivariate random-effects meta-analyses were used to estimate mean correlation (95% CIs) between factors and pain. Sensitivity analysis was performed for each risk of bias domain and certainty of evidence was assessed. Results Of 13,640 studies, 29 reports of 10,360 patients and 61 factors were analysed. The mean correlation between preoperative factors and more severe pain at twelve months was estimated to be 0.36 (95% CI, 0.24, 0.47; P < .000; moderate-certainty evidence) for more catastrophizing, 0.15 (95% CI; 0.08, 0.23; P < .001; moderate-certainty evidence) for more symptomatic joints, 0.13 (95% CI, 0.06, 0.19; P < .001; very low-certainty evidence) for more preoperative pain. Mean correlation between more severe radiographic osteoarthritis and less pain was -0.15 (95% CI; -0.23, -0.08; P < .001; low-certainty evidence). In sensitivity analysis, the estimated correlation coefficient for pain catastrophizing factor increased to 0.38 (95% CI 0.04, 0.64). At six and three months, more severe preoperative pain was associated with more pain. Better preoperative mental health was associated with less pain at six months. Conclusion and relevance More pain catastrophizing, more symptomatic joints and more pain preoperatively were correlated with more pain, while more severe osteoarthritis was correlated with less pain one year after TKA. More preoperative pain was correlated with more pain, and better mental health with less pain at six and three months. These findings should be further tested in predictive models to gain knowledge which may improve TKA outcomes.

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Section: Plos Onesupporting

confidence: 90%

Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis

et al. 2023

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“…Additionally, the systematic review by Sayah et al revealed that functional limitations including IADL disability improved drastically in six months and gradually keep improving 2 years after TKA. 45 Therefore, our study population, especially participants in group 3, could potentially improve IADL disability six months postoperatively. However, considering the relationship between IADL disability, adverse events, 10, 12 and general rehabilitative intervention periods after KA, 16, 17 such patients are at high risk for adverse events and require careful follow-up even beyond six months postoperatively.…”

Section: Discussionmentioning

confidence: 95%

Preoperative predictors of instrumental activities of daily living disability in older adults six months after knee arthroplasty

Nanjo

Ikeda

Nagashio

et al. 2022

Preprint

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Objective: To investigate preoperative predictors of instrumental activities of daily living (IADL) disability in older adults six months after knee arthroplasty (KA). Design: Prospective study. Setting: General hospital with an orthopedic surgery department. Participants: Two hundred twenty (N = 220) patients ≥ 65 years old with total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA). Interventions: Not applicable. Main Outcome Measure: IADL status was evaluated for six activities. Participants chose ″able″, ″need help″, or ″unable″ according to their capacity of executing these IADL activities. If they chose ″need help″ or ″unable″ for one or more items, they were defined as ″disabled″. Their usual gait speed (UGS), range of motion for the knee, isometric knee extension strength (IKES), pain status, depressive symptoms, pain catastrophizing, and self-efficacy were evaluated as predictors. Baseline and followup assessments were conducted one month before and six months after KA, respectively. Logistic regression analyses with IADL status as the dependent variable were performed at follow-up. All models were adjusted using age, sex, severity of the knee deformity, operation type (TKA or UKA) and preoperative IADL status as covariates. Results: In total, 166 patients completed the follow–up assessment, and 83 (50.0%) reported IADL disability six months after KA. Preoperative UGS, IKES on the non-operated side and self-efficacy were significantly different between those with a disability at follow-up and those who did not and were therefore included in logistic regression models as independent variables. UGS (odds ratio [OR] = 3.22, 95% confidence interval [95% CI] = 1.38–7.56, p = 0.007) was determined as a significant independent variable. Conclusion: The present study demonstrated the importance of evaluating preoperative gait speed to predict the presence of IADL disability in older adults six months after KA. Therefore, those with poorer preoperative mobility should be provided careful postoperative care and treatment.

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“…KOOS score maps could facilitate a shared decision-making discussion [23]. For example, after our hypothetical patient completes the KOOS subscales, the clinician and patient could discuss score meaning, how it compares to average scores of others receiving KA [27] and the patient's likely KOOS score outcome 1 year following surgery. Score maps can, in essence, convey meaning of these unitless scores in a way that may facilitate understanding.…”

Section: Shared Decision-making Discussion and Knee Arthroplasty Cand...mentioning

confidence: 99%

KOOS score maps were externally validated to inform knee arthroplasty shared decision making

Riddle

2023

Knee Surg Sports Traumatol Arthrosc

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PurposeThe Knee injury and Osteoarthritis Outcome Survey (KOOS) proile of outcome measures are among the most commonly used outcome measures in knee arthroplasty (KA). The purpose was to develop and externally validate "score maps" (one-page igural depictions of most likely scores) for KOOS Pain and Function subscales to facilitate a variety of clinical decisions related to shared decision making prior to KA. Methods Presurgical KA data collected within 1 year of surgery and obtained in two independent studies were used in this cross-sectional study. Score maps were designed to be easily understandable, single-page graphical depictions of predicted KOOS Pain, and KOOS Function, daily activity subscales. To create the score maps, individual item scores from one dataset were used to determine the most probable responses for each item for the entire range of possible scores. Predicted KOOS score maps were derived from Osteoarthritis Initiative (OAI) data and externally validated using an independent single site KA cohort study. Score map predicted scores from OAI were compared to actual presurgical KOOS subscale scores using Weighted Kappa (Κ w ) agreement coeicients and actual versus predicted diferences in scores. ResultsThe score maps derived from OAI and applied to actual scores in the validation sample demonstrated moderate to substantial chance-corrected agreement for both KOOS Pain and KOOS Function, daily activity subscale items. For example, KOOS Pain score map scores applied to the external validation dataset showed chance-corrected agreement with Κ w ranging from 0.43 to 0.73. Score maps predicted actual item scores within ± 1 point at least 94% of the time. Findings for the KOOS Function, daily activity subscale items were similar. Conclusions Score maps derived from OAI data agreed with actual KOOS scores obtained on an independent dataset at an acceptable degree of precision. Easy-to-use KOOS Pain and Function, daily activity score maps have potential to facilitate a variety of important clinical decisions during discussions between patients and surgeons prior to KA. Level of evidenceLevel III prognostic study. Keywords Knee; arthroplasty; clinical decision making • Outcome • Pain • Function • PROMS • Patient-related outcome scoring Abbreviations KA Knee arthroplasty KOOS Knee injury and osteoarthritis outcome survey K w Weighted kappa NIH National institutes of health OA Osteoarthritis OAI Osteoarthritis initiative PROMIS Patient-reported outcomes measurement information system PROMs Patient-reported outcome measures SPSS Statistical package for the social sciences * Daniel L. Riddle

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Clinical Course of Pain and Function Following Total Knee Arthroplasty: A Systematic Review and Meta-Regression

Cited by 38 publications

References 209 publications

Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis

Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis

Preoperative predictors of instrumental activities of daily living disability in older adults six months after knee arthroplasty

KOOS score maps were externally validated to inform knee arthroplasty shared decision making

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