Factors Related to Postoperative Pain Trajectories following Total Knee Arthroplasty: A Longitudinal Study of Patients Admitted to a Russian Orthopaedic Clinic

Abstract

This study explores sociodemographic, clinical, and surgical factors in relation to pain trajectories during the first 3 days following total knee arthroplasty (TKA). 100 patients (mean age 63.5 ± 7.8 years and 93% female) consecutively admitted for uncomplicated primary TKA were prospectively included. Postoperative pain was assessed using pain diaries. Measures of preoperative pain, symptoms, daily functioning, quality of life, comorbidities, knee function, perioperative characteristics, and physical/biochemical parameters were also evaluated. All pain ratings decreased in the three days following surgery (p < .001) as well as the reported number of daily hours in moderate/severe pain (p < .001). Women reported more pain than men (p = .009). Pain trajectories did not differ by education, employment, cohabitation, or any patient clinical and biochemical characteristics but were significantly related to preoperative anxiety (p = .029). Patients reporting moderate/severe pain prior to surgery also reported more hours in moderate/severe pain on days 0–3 postoperatively (p = .029). Patients with surgeries longer than 90 min reported more hours of moderate/severe pain compared with patients who had shorter surgeries (p = .008), and similar results were observed for ratings of pain with activity (p = .012). In this sample, only female gender, higher levels of preoperative pain and anxiety, and longer surgical duration were associated with increased pain after TKA.

Women report higher pain intensity at a lower level of inflammation after knee surgery compared with men

“…Pain intensity after knee surgery may be influenced by preoperative pain intensity. 14 The patient population in our study was generally healthy and reported low preoperative pain intensity. Pain responders experienced slightly higher preoperative pain intensity than nonresponders.…”

Investigating the True Effect of Psychological Variables Measured Prior to Arthroplastic Surgery on Postsurgical Outcomes: A P-Curve Analysis

“…Following this initial review, 46 full-texts were assessed for eligibility of which 20 manuscripts were excluded for at least one of the following reasons: non-significant findings (n = 6) 1,10,48,56,58,63 , the analyses/results were not relevant to review hypotheses (n = 6) 6,9,20,35,42,90 , and the critical test statistic was not reported, could not be computed based on reported data, and could not be obtained after contact with the author (n = 3) 3,18,86 (see Figure 1). The latter criterion included studies reporting pvalue ranges (e.g.…”

Pain Trajectory After Ankle Surgeries for Osteoarthritis

“…Page et al showed that patients with high pain trajectory after knee replacement had more severe preoperative pain, more preoperative functional impact, and more psychological distress. 24 Kornilov et al 15 showed that high pain trajectory were significantly related to preoperative anxiety. The preoperative morphine consumption has also been linked to a higher intensity of postoperative pain 11 and to a more gentle slope of pain resolution after major surgeries.…”

“…The median pain intensity score in the postoperative acute care unit was 4 (0-7), the median morphine titration doses were 6 mg (0-7) and cumulative consumption over the first 48 hours after surgery was 11 mg (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Sixteen patients (34%) had a high pain trajectory.…”