“It's there and I'm stuck with it”: Patients' experiences of chronic pain following total knee replacement surgery

Jeffery, Alison E.; Wylde, Vikki; Blom, Ashley W; Horwood, Jeremy

doi:10.1002/acr.20360

Cited by 65 publications

(112 citation statements)

References 42 publications

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“…This finding is consistent with the findings of two other studies which have tried to define orthopaedic referral criteria through consensus for knee arthroplasty (Musila et al, ) and hip arthroplasty (Quintana et al, ). Although many clinicians consider the patient's pain to be an important contributor to decisions about referral, it is well known that the patient's pain and the underlying pathology are not necessarily highly correlated (Gatchel et al, ; Jeffery et al, ). The subjective nature of pain symptoms reduces the value of this parameter as a guide to appropriate patient referral; however, it does provide insight into the key determinants which influence surgery.…”

Section: Discussionsupporting

confidence: 91%

Surgical Referral Criteria for Degenerative Rotator Cuff Tears: A Delphi Questionnaire Study

Griffiths

Yohannes

2013

Musculoskelet. Care

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Selecting the most appropriate patients to refer for surgery is crucial for high-quality and efficient clinical care. However, there are no specific referral criteria to guide the referral of appropriate patients for rotator cuff repair surgery. The aim of the present study was to design robust surgical referral criteria for patients with degenerative rotator cuff tears using consensus methodology. A two-round Delphi questionnaire was undertaken with a nationally representative sample of 41 specialist shoulder surgeons experienced in rotator cuff repair. Surgical referral criteria for degenerative rotator cuff tear were developed where consensus of at least 70% agreement was achieved. The initial questionnaire consisted of 24 items. Consensus was reached on 14 items, including: severity of pain, functional limitation, the identification of fat atrophy, agreement that a course of physiotherapy should be attempted before surgical referral, and exclusion for those with an active frozen shoulder. However, there was no consensus with regard to the dimensions of the tear. The surgical referral criteria developed were novel and promising for patients with degenerative rotator cuff tears, and further research is required to examine their efficacy.

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Section: Discussionsupporting

confidence: 91%

Surgical Referral Criteria for Degenerative Rotator Cuff Tears: A Delphi Questionnaire Study

Griffiths

Yohannes

2013

Musculoskelet. Care

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“…Factors found to influence patient satisfaction include knee pain, stiffness, and functioning before and after TKA, postoperative complications, and patient characteristics including expectations, social support, age, gender, and ethnicity [10–15]. The second major approach qualitatively investigates particular aspects of the patient experience before and after TKA surgery, including deciding to have or not have surgery [16, 17], waiting for surgery [18, 19], pre-surgery pain [20], pre-surgery education [21, 22], post-surgery pain [23], the hospital experience [24], rehabilitative practices [25], managing recovery [26, 27], and returning to physical activity [28, 29]. While it is helpful that these two approaches to patient perspective research exist, it is difficult to integrate and more deeply understand their results.…”

Section: Introductionmentioning

confidence: 99%

The importance of informational, clinical and personal support in patient experience with total knee replacement: a qualitative investigation

Goldsmith

Suryaprakash

Randall

et al. 2017

BMC Musculoskelet Disord

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BackgroundTotal knee arthroplasty (TKA) is the most frequently performed joint replacement surgery in North America. Patient perspectives on TKA have been investigated in various ways, including finding as many as 20% of TKA patients are dissatisfied with their surgical outcomes. Understanding the patient experience with TKA broadly and in relation to patient satisfaction is a key gap in existing literature.MethodsWe report on the qualitative component of a mixed methods prospective cohort study examining patient experience and satisfaction post-TKA for adults in British Columbia, Canada. Data collection consisted of 45 in-depth interviews about individuals’ knee surgery experiences conducted eight months after surgery. Analysis consisted of thematic coding by multiple coders.ResultsParticipants’ descriptions of their TKA experiences were primarily concerned with support, or the provision of aid and assistance. Support was insufficient when their expectations of support were not met; unmet support expectations led to an overall negative TKA experience. Support operated in three key domains: (1) informational support, (2) clinical support, and (3) personal support. Key sources of informational and clinical support included pre-optimisation clinics, surgeons, and physiotherapists. Key topics for informational support included pain, pain management, and recovery trajectories. Personal support was provided by family, friends, other TKA patients, employers, and themselves.ConclusionsPatient needs and expectations for support are shaped both before and after TKA surgery. Patients with an overall positive TKA experience had improvement in their knee pain, stiffness or functioning post-TKA, had their major expectations and needs for support met during their TKA recovery, and believed that any significant future expectations or needs for ongoing support would be adequately met. In contrast, patients with an overall negative TKA experience had at least one major expectation or need for support not met during their TKA recovery, even in cases where they had good TKA outcomes. Suggested interventions to improve the experience of persons receiving TKA include an expanded patient navigator model, revised pre-surgery educational materials, particularly around pain expectations and management, and comprehensive sharing of other patients’ TKA experience.

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“…In the longer term, 7 – 23% of THR patients and 10 – 34% of TKR patients report moderate to severe pain following surgery 3. Chronic postsurgical pain can be distressing 4 and has a considerable socioeconomic cost 5.…”

Section: Introductionmentioning

confidence: 99%

Rest Pain and Movement‐Evoked Pain as Unique Constructs in Hip and Knee Replacements

Sayers

Wylde

Lenguerrand

et al. 2016

Arthritis Care & Research

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ObjectiveThere is limited information about the extent to which the association between preoperative and chronic postoperative pain is mediated via pain‐on‐movement or pain‐at‐rest. We explored these associations in patients undergoing total hip replacement (THR) and total knee replacement (TKR).MethodsA total of 322 and 316 patients receiving THR and TKR, respectively, were recruited into a single‐center UK cohort (Arthroplasty Pain Experience) study. Preoperative, acute postoperative, and 12‐month pain severity was measured using self‐reported pain instruments. The association between preoperative/acute pain and chronic postoperative pain was investigated using structural equation modeling (SEM).ResultsPatients with high levels of preoperative pain were more likely to report chronic pain after THR (β = 0.195, P = 0.02) and TKR (β = 0.749, P < 0.0001). Acute postoperative pain‐on‐movement was not associated with chronic pain after TKR or THR after adjusting for preoperative pain; however, acute pain‐at‐rest was associated with chronic pain after THR (β = 0.20, P < 0.0002) but not TKR after adjusting for preoperative pain. Analysis of pain‐at‐rest and pain‐on‐movement highlighted differences between THR and TKR patients. Chronic pain‐at‐rest after THR was weakly associated with pain‐at‐rest during the preoperative (β = 0.11, P = 0.068) and acute postoperative period (β = 0.21, P < 0.0001). In contrast, chronic pain‐on‐movement after TKR was strongly associated with the severity of pain‐on‐movement during the preoperative period (β = 0.51, P = 0.001).ConclusionSEM illustrated the different patterns of association between measures of pain over time in patients undergoing THR and TKR for osteoarthritis. These findings highlight the importance of future work that explores the mechanisms underlying pain‐on‐movement and pain‐at‐rest.

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“It's there and I'm stuck with it”: Patients' experiences of chronic pain following total knee replacement surgery

Abstract: Objective. To gain insight into patients' experiences of adjustment to chronic pain following recovery from total knee replacement (TKR) surgery.

Cited by 65 publications

References 42 publications

Surgical Referral Criteria for Degenerative Rotator Cuff Tears: A Delphi Questionnaire Study

Surgical Referral Criteria for Degenerative Rotator Cuff Tears: A Delphi Questionnaire Study

The importance of informational, clinical and personal support in patient experience with total knee replacement: a qualitative investigation

Rest Pain and Movement‐Evoked Pain as Unique Constructs in Hip and Knee Replacements

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