Do Knee Pain Phenotypes Have Different Risks of Total Knee Replacement?

Abstract

Pain is the main impetus for osteoarthritis (OA) patients to seek healthcare including joint replacement. The pain experience in OA is heterogeneous and affected by factors across multiple domains—peripheral, psychological, and neurological. This indicates the existence of homogenous subgroups/phenotypes within OA patients with pain. We recently identified three pain phenotypes using a wide spectrum of pain-related factors, including structural damage on magnetic resonance imaging (MRI), emotional problems, number of painful sites, sex, body mass index, education level and comorbidities (i.e., Class 1: high prevalence of emotional problems and low prevalence of structural damage (25%); Class 2: low prevalence of emotional problems and high prevalence of structural damage (20%); Class 3: low prevalence of emotional problems and low prevalence of structural damage (55%)). This study was to examine whether the total knee replacement (TKR) risk over 12 years was different among these three pain phenotypes. Data on 963 participants (mean age 62.8 ± 7.4 years) from a population-based cohort study were utilised. Data on socio-demographic, psychological and comorbidities were collected. MRI of the right knee structural pathology was performed. TKR history was ascertained by linking to the Australian Orthopedic Association National Joint Replacement Registry. Latent class analysis and the Cox proportional hazards model were applied for the analysis. During the follow-up period, 41 right and 44 left TKRs in 67 participants were identified. In multivariable analyses, participants in Class 1 and 2 had a higher risk of having a TKR (Class 1 vs. Class 3, HR (hazard ratio) 4.81, 95%CI (confidence interval) 2.33–9.93; Class 2 vs. Class 3, HR 9.23, 95%CI 4.66–18.30). These associations were stronger in the imaged right knee but were also significant in the left knee. Participants within distinct pain phenotypes have different risks of TKR, suggesting that the identified phenotypes reflect distinct clinical subgroups with different prognoses. The risk for TKR was higher in Class 1 than that in Class 3, suggesting that pain/emotional status is a stronger driver for TKR than structural damage, and that selecting patients for TKR needs to be optimized in clinical practice.

Translating clinical and patient-reported data to tailored shared decision reports with predictive analytics for knee and hip arthritis

“…Real-time access to big data during the clinician-patient encounter provides an opportunity to make the best treatment decisions in individual situations [ 4 ]. These aggregate datasets can be transformed to individualized information to guide shared decision-making between patients and clinicians in arthritis care [ 5 ]. Efforts to transform comprehensive real-world evidence to individualized, actionable information require health systems to develop best practices for integrating PROs with real-world data to support shared decision-making [ 6 ].…”

THE IMPACT: Education Level Has a Relativity for The Recovery of Total Knee Arthroplasty: a meta-analysis of randomized controlled trials

“…White et al [15] believes that perioperative education can well improve the postoperative knee exion, 72% of the patients with good perioperative education can kneel with their affected knees 1 year after the surgery. The acceptance of perioperative knowledge, such as eliminating fear, avoiding rough training, controlling training methods and time, and comprehensive pain control, largely depends on the patient's EL [16] .…”

“…Postoperative pain is the most common symptom complained by patients [27] . The preoperative patient's psychology is an important factor affecting the pain of patients after TKA [16,28] . It is still a di culty that how to identify better whether patients are at high risk of complications owing to psychiatric disorders [13] .…”

Association of Pain Phenotypes with Risk of Falls and Incident Fractures

“…Measurements of knee structural abnormalities on MRI, emotional problems, number of painful sites, BMI, sex, education level, and comorbidities, which were measured by trained observer(s) or self-report questionnaires at baseline, were used to identify pain phenotypes. The details of each measurement have been described elsewhere [ 25 , 26 ]. In brief, each participant had an MRI scan on their right knee in the sagittal plane on a 1.5-T whole body MR unit (Picker, OH) using a commercial transmit–receive extremity coil.…”

“…Our recent study has identified three distinctive knee pain phenotypes by considering a broad range of pain-related factors, including structural abnormalities on magnetic resonance imaging (MRI), emotional issues, body mass index (BMI): Class 1: high prevalence of emotional problems and low prevalence of structural damage (38%); Class 2: high prevalence of structural damage and low prevalence of emotional problems (17%); Class 3: low prevalence of emotional problems and low prevalence of structural damage (45%) [ 25 , 26 ]. Further, pain severity and number of painful sites were found to be different between the classes/subgroups [ 26 ].…”