Predicting Persistent Unclear Pain Following Primary Total Knee Arthroplasty

Abstract

Chronic post-surgical pain can be a considerable issue for patients undergoing primary total knee arthroplasty. According to the literature, persistent knee pain is experienced by up to 44% of patients. Most studies on total knee arthroplasty (TKA) outcomes have mainly investigated the biomechanics or function of the operated knee, but chronic pain has never been a primary issue. In recent years several possible predictors of chronic postsurgical pain have been investigated and eventually identified. A younger age, female gender, psychological distress, preoperative pain duration and intensity were all reported to influence chronic postoperative pain rates after total knee arthroplasty. Recently, it has also been hypothesized that preoperative signs of centrally driven hyperalgesia and distorted pain modulation may predict persistent knee pain in some patients. Despite the considerable number of patients suffering from chronic postsurgical pain after TKA, available data is scarce, and well controlled prospective studies are lacking. Predictors of chronic postsurgical pain after total knee arthroplasty have yet to be identified. Thus, this article is aimed at reviewing current knowledge on persistent pain after knee arthroplasty.

Preoperative risk factors associated with chronic pain profiles following total knee arthroplasty

“…A variety of risk factors for the development of chronic pain following TKA have been identified, including multiple painful sites (Lewis et al, 2015), lower grade of osteoarthritis (OA) (Dowsey et al, 2012; Niinimaki et al, 2011), female gender, younger age (Singh et al, 2008), previous knee surgeries (Skou et al, 2013), higher preoperative (Noiseux et al, 2014) and perioperative pain intensity (Puolakka et al, 2010) and poorer psychological state (Lewis et al, 2015). However, as noted in three systematic reviews (Chodor & Kruczynski, 2016; Harmelink et al, 2017; Wylde et al, 2018), a large amount of heterogeneity exists across studies; they focused mainly on biomechanical factors; and were primarily registry‐based, retrospective, or secondary analyses of randomized controlled trials. Therefore, the fundamental processes that underlie the transition from acute to chronic pain after TKA are poorly understood (Katz & Seltzer, 2009) and the evidence on risk factors is weak (Harmelink et al, 2017).…”

Managing Prolonged Pain After Surgery: Examining the Role of Opioids

“…The association with male gender may seem somewhat surprising as previous studies have linked the risk of chronic postsurgical pain (CPSP) to younger females [2,3]. However, this is a key distinction, that is, the difference between CPSP and chronic opioid use.…”

Designing and conducting proof-of-concept chronic pain analgesic clinical trials

“…Predefining the mechanistic classification of patients to categorize likely responders is a developing area of considerable excitement. Although this manner of deep phenotyping, comprehensively assessing factors of interest, has spurred a number of studies exploring postoperative pain outcomes 12,28 and at least one large population-based study to identify characteristics that contribute to the onset and persistence of pain, 111 POC and other clinical trials have been slower to use these concepts. Recent IMMPACT meetings have focused on improving assay sensitivity, 47 patient phenotyping in clinical trials of chronic pain, 50 and on specific viable biomarkers, including sensory testing, skin punch biopsy, and brain imaging, suggesting a number of promising tools for incorporation into clinical trial design.…”