Preoperative Risk Factors of Persistent Pain following Total Knee Arthroplasty

Chodór, Paweł; Kruczyński, Jacek

doi:10.1155/2022/4958089

Cited by 8 publications

(5 citation statements)

References 43 publications

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“…Sample sizes ranged from 26 [43] to 5309 [50]. We excluded eight studies from analysis because attempts to obtain missing data from authors were unsuccessful or insufficient [62][63][64][65][66][67][68][69]. The search strategy, subject headings and keywords customized for all databases is presented in S8 Appendix and reasons for study exclusion are in S9 Appendix.…”

Section: Resultsmentioning

confidence: 99%

Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis

et al. 2023

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Main objective Systematically review and synthesize preoperative and intraoperative factors associated with pain after total knee arthroplasty (TKA) in patients with osteoarthritis. Methods Based on a peer-reviewed protocol, we searched Medline, Embase, CINAHL, Cochrane Library, and PEDro for prospective observational studies (January 2000 to February 2023) investigating factors associated with pain after TKA. The primary outcome was pain twelve months after TKA. Pain at three and six months were secondary outcomes. Multivariate random-effects meta-analyses were used to estimate mean correlation (95% CIs) between factors and pain. Sensitivity analysis was performed for each risk of bias domain and certainty of evidence was assessed. Results Of 13,640 studies, 29 reports of 10,360 patients and 61 factors were analysed. The mean correlation between preoperative factors and more severe pain at twelve months was estimated to be 0.36 (95% CI, 0.24, 0.47; P < .000; moderate-certainty evidence) for more catastrophizing, 0.15 (95% CI; 0.08, 0.23; P < .001; moderate-certainty evidence) for more symptomatic joints, 0.13 (95% CI, 0.06, 0.19; P < .001; very low-certainty evidence) for more preoperative pain. Mean correlation between more severe radiographic osteoarthritis and less pain was -0.15 (95% CI; -0.23, -0.08; P < .001; low-certainty evidence). In sensitivity analysis, the estimated correlation coefficient for pain catastrophizing factor increased to 0.38 (95% CI 0.04, 0.64). At six and three months, more severe preoperative pain was associated with more pain. Better preoperative mental health was associated with less pain at six months. Conclusion and relevance More pain catastrophizing, more symptomatic joints and more pain preoperatively were correlated with more pain, while more severe osteoarthritis was correlated with less pain one year after TKA. More preoperative pain was correlated with more pain, and better mental health with less pain at six and three months. These findings should be further tested in predictive models to gain knowledge which may improve TKA outcomes.

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Section: Resultsmentioning

confidence: 99%

Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis

et al. 2023

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“…The present study found that preoperative VAS scores influenced the achievement of beneficial outcomes. In fact, preoperative knee pain was identified as a significant contributor to poor outcomes after TKA and increased the risk of postoperative dissatisfaction by 2.49-fold 9 , 40 . The VAS for pain is a common method for evaluating arthritis pain and is a highly sensitive metric 41 .…”

Section: Discussionmentioning

confidence: 99%

Prediction of early functional outcomes in patients after robotic-assisted total knee arthroplasty: a nomogram prediction model

Duan

Zhao

Zhang

et al. 2023

International Journal of Surgery

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Background: Robotic-assisted total knee arthroplasty (RA-TKA) is becoming more and more popular as a treatment option for advanced knee diseases due to its potential to reduce operator-induced errors. However, the development of accurate prediction models for postoperative outcomes is challenging. This study aimed to develop a nomogram model to predict the likelihood of achieving a beneficial functional outcome. The beneficial outcome is defined as a postoperative improvement of the functional Knee Society Score (fKSS) of more than 10 points, 3 months after RA-TKA by early collection and analysis of possible predictors. Methods: This is a retrospective study on 171 patients who underwent unilateral RA-TKA at our hospital. The collected data included demographic information, preoperative imaging data, surgical data, and preoperative and postoperative scale scores. Participants were randomly divided into a training set (N=120) and a test set (N=51). Univariate and multivariate logistic regression analyses were employed to screen for relevant factors. Variance inflation factor was used to investigate for variable collinearity. The accuracy and stability of the models were evaluated using calibration curves with the Hosmer–Lemeshow goodness-of-fit test, consistency index and receiver operating characteristic curves. Results: Predictors of the nomogram included preoperative hip-knee-ankle angle deviation, preoperative 10-cm Visual Analogue Scale score, preoperative fKSS score and preoperative range of motion. Collinearity analysis with demonstrated no collinearity among the variables. The consistency index values for the training and test sets were 0.908 and 0.902, respectively. Finally, the area under the receiver operating characteristic curve was 0.908 (95% CI 0.846–0.971) in the training set and 0.902 (95% CI 0.806–0.998) in the test set. Conclusion: A nomogram model was designed hereby aiming to predict the functional outcome 3 months after RA-TKA in patients. Rigorous validation showed that the model is robust and reliable. The identified key predictors include preoperative hip-knee-ankle angle deviation, preoperative visual analogue scale score, preoperative fKSS score, and preoperative range of motion. These findings have major implications for improving therapeutic interventions and informing clinical decision-making in patients undergoing RA-TKA.

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Section: Risk Factors For Chronic Pain After Total Knee Arthroplastymentioning

confidence: 99%

“…For opioid use, higher presurgical opioid consumption has been associated with use of higher oral morphine equivalents (OME) more than 6 months after surgery compared with patients with no or low opioid use before surgery [10]. Duration of pain before undergoing surgery has also been shown to be a risk factor [4] as well as the combination of high preoperative pain and low radiographic evidence of osteoarthritis [11]. There is some evidence that psychological risk factors also play a role in CPSP after TKA, with evidence that persons with central sensitization of pain and higher levels of pain catastrophizing have higher risk of persistent pain [12,13].…”

Section: Risk Factors For Chronic Pain After Total Knee Arthroplastymentioning

confidence: 99%

“…Chronic postsurgical pain (CPSP) is presently defined as pain 'persisting at least three months after surgery, that was not present before surgery, or that had different characteristics or increased intensity from preoperative pain' [2]. The incidence of CPSP following TKA varies based on the cohort and sampling techniques applied, with most studies identifying a range of 15-25%, [3,4], though estimates have suggested as many as one in three persons experience ongoing pain following this type of surgery. Persistent pain negatively impacts several aspects of the patient experience, leading to higher healthcare costs and worse patient satisfaction [5], as well as functional disability and decreases in quality of life [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Advances in the management of persistent pain after total knee arthroplasty

Dembek,

Bicket

2023

Current Opinion in Anaesthesiology

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Purpose of reviewTotal knee arthroplasty (TKA) is one of the most commonly performed surgical procedures, with additional growth anticipated as the US population ages. Because the prevalence of chronic postsurgical pain ranges from 15 to 25%, identifying persons at risk for persistent pain following surgery allows for preoperative optimization of risk factors as well as early identification and intervention in the postsurgical period. Recent findingsClinical understanding of available management techniques is critical to management, which should focus on improving patient mobility and satisfaction while reducing patient disability and healthcare costs. Current evidence supports a multimodal management strategy. This includes pharmacologic and nonpharmacologic interventions, procedural techniques, and identification and optimization of psychosocial and behavioral contributors to chronic pain. Procedural techniques known to confer analgesia include radiofrequency and watercooled neurotomy techniques. More recently, case reports have been published describing analgesic benefit with central or peripheral neuromodulation as a novel, though more invasive analgesic therapy.

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Preoperative Risk Factors of Persistent Pain following Total Knee Arthroplasty

Cited by 8 publications

References 43 publications

Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis

Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis

Prediction of early functional outcomes in patients after robotic-assisted total knee arthroplasty: a nomogram prediction model

Advances in the management of persistent pain after total knee arthroplasty

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