Prediction of persistent pain after total knee replacement for osteoarthritis

Lundblad, Henrik; Kreicbergs, Andris; Jansson, Karl-Åke

doi:10.1302/0301-620x.90b2.19640

Cited by 244 publications

(308 citation statements)

References 23 publications

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“…Recently, high pre-operative pain at rest and a low pain threshold, assessed by the use of an electrical stimulus (Painmatcher) has been shown to correlate with pain 18 months following total knee arthroplasty [20]. Our study did not show any clinically relevant correlations between the use of pre-operative opioids or pain intensity and the development of subacute postoperative pain.…”

Section: Discussioncontrasting

confidence: 56%

Subacute pain and function after fast‐track hip and knee arthroplasty

Andersen¹,

Gaarn-Larsen²,

et al. 2009

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Summary In a well‐defined fast‐track setup for total hip and knee arthroplasty, with a multimodal analgesic regimen consisting of intra‐operative local anaesthetic infiltration and oral celecoxib, gabapentin and paracetamol for 6 days postoperatively, we conducted a prospective, consecutive, observational study. The purpose was to describe the prevalence and intensity of subacute postoperative pain and opioid related side effects, use of analgesics and functional ability 1–10 and 30 days postoperatively. Fast‐track total hip and knee arthroplasty with early discharge (< 3 days) resulted in acceptable levels of pain and postoperative nausea and vomiting with concomitant low use of opioids in > 95% of patients after discharge before day 10 after total hip arthroplasty. However, after total knee arthroplasty 52% patients reported moderate pain (VAS 30–59 mm), and 16% severe pain (VAS ≥ 60 mm) when walking 1 month after surgery with a concomitant increase in the use of strong opioids. These results emphasise the need for improvement in analgesia after discharge following total knee arthroplasty, to facilitate rehabilitation.

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Section: Discussioncontrasting

confidence: 56%

Subacute pain and function after fast‐track hip and knee arthroplasty

Andersen¹,

Gaarn-Larsen²,

et al. 2009

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“…In large studies, women have more pain both before and after arthroplasty ( Table 2). Women had both lower sensation and pain thresholds than men after TKA [21]. Moreover, in a small study of only six men and six women with knee osteoarthritis, positron emission tomography imaging of the brain showed arthritic pain is processed in areas of the brain concerned with emotion and fear [15].…”

Section: Discussionmentioning

confidence: 99%

“…Sex-related differences in the pain mechanisms may influence outcomes. In a small study of patients with knee osteoarthritis undergoing TKA, Lundblad et al [21] showed women had lower sensation thresholds and pain thresholds than men. Pain at rest and lower preoperative pain threshold were associated with postoperative pain at rest.…”

Section: Preoperative and Postoperative Painmentioning

confidence: 99%

Implant Survival, Knee Function, and Pain Relief After TKA: Are There Differences Between Men and Women?

O’Connor

2011

Clinical Orthopaedics &Amp; Related Research

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Background As efforts continue to improve the results of TKA, the potential influence of sex and gender on longterm survival of implants, knee function, pain relief, and patient satisfaction remains relevant, particularly given the increased incidence of osteoarthritis of the knee in women and reports that women derive equal benefit from TKA. Questions/purposes This article reviews the literature pertinent to the question of whether long-term survival, knee function, pain relief, and patient satisfaction after TKA differ between men and women. Methods Large clinical series ([ 1000 patients) published in the last 10 years were identified in PubMed and reviewed. Results Men may be at higher risk of revision surgery than women. Sex/gender has been consistently shown to impact both function and pain relief both before and after TKA. Although women achieve at least the same degree of functional improvement as men, women have worse preoperative physical function and do not reach the same final level of physical function as men. Likewise women may have similar or even greater improvement in pain after arthroplasty than men but still have final pain scores that are less favorable. Conclusions Further research is required to understand the sex and gender differences contributing to implant survival, physical function, and pain relief after TKA.Strategies need to be developed to identify any patient who is at higher risk of implant failure, suboptimal postoperative function, and incomplete pain relief.

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“…2 Identification of distal hyperalgesia is clinically important and has been associated with poorer recovery in patients with acute whiplash injury, 15,28 as well as increased pain after total knee replacement. 19 …”

mentioning

confidence: 99%

Lower Mechanical Pressure Pain Thresholds in Female Adolescents With Patellofemoral Pain Syndrome

Rathleff¹,

Roos²,

Olesen³

et al. 2013

Journal of Orthopaedic & Sports Physical Therapy

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Study Design Cross-sectional study. Objectives To compare pressure pain thresholds (PPTs) between adolescent females diagnosed with patellofemoral pain syndrome (PFPS) and gender- and age-matched controls without musculoskeletal pain. Background PFPS is prevalent among adolescents and may be associated with reduced PPT both locally and remotely from the site of reported pain. This may indicate altered central processing of nociceptive information. However, this has never been investigated in adolescents with PFPS. Methods Adolescents with PFPS and a comparison group without musculoskeletal pain were recruited from a population-based cohort of students from 4 upper secondary schools, aged 15 to 19 years. All 2846 students within that age range were invited to answer an online questionnaire regarding musculoskeletal pain. The students who reported knee pain were contacted by telephone and offered a clinical examination by an experienced rheumatologist, who made a diagnosis. PPTs were measured at 4 sites around the knee and 1 site on the tibialis anterior in the 57 female adolescents diagnosed with PFPS and in 22 female adolescents without musculoskeletal pain. Results Adolescents with PFPS, compared to controls, had significantly lower PPTs (26%–37% [100–178 kPa]) at each of the 4 sites around the knee, suggesting localized hyperalgesia. On the tibialis anterior, adolescents with PFPS had a 33% (159 kPa) lower PPT (distal hyperalgesia) compared with controls. Conclusion These findings suggest that adolescent females with PFPS have localized and distal hyperalgesia. These findings may have implications for treating PFPS, as both peripheral and central mechanisms may be driving the pain. Registered at clinicaltrials.gov (NCT01438762). J Orthop Sports Phys Ther 2013;43(6):414–421. Epub 18 March 2013. doi:10.2519/jospt.2013.4383

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Prediction of persistent pain after total knee replacement for osteoarthritis

Cited by 244 publications

References 23 publications

Subacute pain and function after fast‐track hip and knee arthroplasty

Subacute pain and function after fast‐track hip and knee arthroplasty

Implant Survival, Knee Function, and Pain Relief After TKA: Are There Differences Between Men and Women?

Lower Mechanical Pressure Pain Thresholds in Female Adolescents With Patellofemoral Pain Syndrome

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