Incidence and risk factors for development of persistent postsurgical pain following total knee arthroplasty

Abstract

Persistent postsurgical pain (PPP) is defined as the discomfort that lasts >3 months postoperatively. The primary aim of this retrospective study was to estimate the risk of developing moderate-to-severe PPP after primary total knee arthroplasty (TKA). The secondary goal was to explore potential predictors of this outcome. Data were collected via hospital arthroplasty registry and chart review. The risk of moderate-to-severe PPP, defined as ≥4 on the numerical rating scale (NRS) at minimum of 3 months post-surgery, was calculated. Multivariable logistic regression was used to estimate the association of patient demographics, diagnoses, length of hospital stay, and preoperative NRS with the odds of developing PPP. Exploratory, simple logistic regression was used to estimate the association of perioperative factors with the odds of developing PPP on a subset of patients (n = 72). The risk of PPP after TKA was 31.3% (95% confidence interval [CI]: 27.5–35.0) (n = 578). Every 2-point increase in baseline NRS was associated with 1.66 (95% CI: 1.37–2.03) times the odds of developing PPP ( P < .001). African-Americans (vs whites) had 1.82 (95% CI: 1.03–3.22) times the odds of developing PPP ( P = .040). Exploratory analysis suggested that the adductor canal saphenous nerve (vs femoral nerve) blocks were associated with 2.87 (95% CI: 1.00–8.26) times the odds of developing PPP ( P = .049). This study estimated a high risk (31.3%) of moderate-to-severe PPP after primary TKA. This study suggested that higher preoperative pain scores might be associated with greater odds of developing PPP. Moreover, this study suggested the possibility that racial differences and types of peripheral nerve blocks might be associated with greater odds of developing moderate-to-severe PPP after TKA surgery. However, the evidence obtained from our exploratory analysis of limited data certainly requires further exploration in large-scale studies.

Total Knee Arthroplasty Postsurgical Chronic Pain, Neuropathic Pain, and the Prevalence of Neuropathic Symptoms: A Prospective Observational Study in Turkey

“…All 42 patients (100%) included in this study were ) had an NRS of four or higher and developed moderate and severe CPSP at a rate similar to other studies. [16][17][18] Also notably, unlike other studies, no patients were found to have an NRS score of zero and no pain.…”

“… 16 Hasegawa et al 17 reported that the rate of moderate and severe pain was 28% in their study conducted on 154 patients for the prevalence of pain after TKA. Güngör et al 18 examined the NRS scores of 578 TKA patients at least three months postoperatively, and they showed that the incidence of developing CPSP was 31.3%. All 42 patients (100%) included in this study were observed to have an NRS of 1 or higher, and 15 patients (35.8%) had an NRS of four or higher and developed moderate and severe CPSP at a rate similar to other studies.…”

The relative analgesic value of a femoral nerve block versus adductor canal block following total knee arthroplasty: a randomized, controlled, double-blinded study

“…Moreover, multiple studies have reported that while maximum voluntary isometric contraction force of the quadriceps is preserved with adductor canal block, there is no clinical difference in ambulation or rehabilitation outcomes between adductor canal block and femoral nerve block [ 10 , 13 , 28 – 30 ]. Finally, long-term outcomes may also differ depending on the block used: in a retrospective study of over 5,900 patients undergoing unilateral total knee arthroplasty, the use of adductor canal block (vs. femoral nerve block) was associated with 2.87 (95% CI: 1.00–8.26) increased odds of developing persistent postoperative pain, a finding that supports the notion that there is a difference in the overall quality of acute pain control each technique provides [ 31 ].…”

Adductor canal block versus periarticular infiltration for pain control following total knee arthroplasty

“…Although there have been advances in technologies and instrumentations in total knee arthroplasty, pain management after the operation is still evolving. [ 12 – 14 ] Various methods of pain control used in the previous years include epidural analgesia, femoral nerve block, PAI, and systemic analgesia. Perioperative pain management with PAI is a safe and effective method of controlling pain after total knee arthroplasty and it also eliminates the risk associated with FNB of quadriceps weakness.…”