Presence of Night Pain, Neuropathic Pain, or Depressive Disorder Does Not Adversely Affect Outcomes After Total Knee Arthroplasty: A Prospective Cohort Study

Abstract

Background A considerable proportion of patients warranting total knee arthroplasty (TKA) have night pain, neuropathic pain, and/or depressive disorder, which may not be resolved by TKA. This prospective, longitudinal cohort study aimed to document the prevalence of night pain, neuropathic pain, and depressive disorder in patients with advanced knee osteoarthritis undergoing TKA and to determine whether the specific coexisting pain and/or disorder at the time of TKA adversely affected postoperative outcomes. Methods In this study, 148 patients undergoing TKA were longitudinally evaluated. The presence of night pain, neuropathic pain (determined using Douleur Neuropathique 4 [DN4]) and depressive disorder (determined using the Patient Health Questionnaire-9 [PHQ-9]) was determined before and 6 weeks, 3 months and 1 year after TKA. In addition, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and EuroQol-5 Dimension (EQ-5D) scores were assessed before and 1 year after TKA. Potential associations of night pain, neuropathic pain, and/or depressive disorder with pre- and postoperative WOMAC and EQ-5D scores were examined in subgroup analyses. Results Preoperatively, 72% (n = 106) of patients reported night pain, and the prevalences of neuropathic pain and depressive disorder were 15% and 17%, respectively. Preoperatively, compared with patients without night pain, those with night pain had significantly poorer preoperative WOMAC scores, but no significant difference was seen between groups 1 year after TKA. Preoperatively, the WOMAC, EQ-5D, and EQ-5D health scores of patients with neuropathic pain were not significantly different from those of patients without neuropathic pain, and there was no difference in clinical outcome scores 1 year after TKA between these groups. Preoperatively, the patients with depressive disorder showed significantly poorer preoperative WOMAC, EQ-5D, and EQ-5D health scores than those without depressive disorder, but no significant differences in scores were observed 1 year after TKA between these groups. Conclusion This study revealed a considerable prevalence of night pain, neuropathic pain, and depressive disorder in patients undergoing TKA and that patients with these specific conditions reported poorer functional and quality of life scores preoperatively. However, such adverse effects disappeared after TKA. Our study findings suggest that TKA can provide satisfactory outcomes for patients with these specific conditions.

Evaluation of Neuropathic Pain after Total Knee Arthroplasty: Do Yellow Flags Matter?

“…Furthermore, Lee et al investigated 142 patients over the timeframe of one year, to measure the effects of nocturnal pain (72% of patients), neuropathic pain (15% of patients), and depressive disorders (13% of patients) on the outcome of TKA. They concluded that patients with night pain had significantly worse functional and quality of life scores preoperatively, but that these negative effects disappeared after one year and had no influence on the outcome [52]. Their results indicate that the influence of preoperative neuropathic pain, pain at night, and depressive disorder on TKA outcomes may vary over time and require long-term assessment.…”

The Effect of Repetitive Transcranial Magnetic Stimulation (rTMS) on Perioperative Neurocognitive Disorders in Patients after Cardiac Surgery: Study Protocol for a Randomized Controlled Trial

“…(2) Depression symptoms during perioperative surgery Major surgery can cause depression symptoms, which can negatively impact the quality of life and even mortality (41,42). At postoperative day 7 depression symptoms will be assessed, and risk factors, pain, and general health status will be evaluated as potential mechanisms.…”

Effect of Total Hip Arthroplasty on Ipsilateral Lower Limb Alignment and Knee Joint Space Width: Minimum 5-Year Follow-up

“…Total joint arthroplasty, including total hip arthroplasty (THA) and total knee arthroplasty (TKA), is a popular surgical option for elderly patients with advanced joint disease. 1 2 3 4 5 6 7 8 9 10 11 Unlike TKA, THA is not an operation that is commonly known to control the lower limb alignment. However, we can reasonably expect that lower limb alignment is influenced by changes in the hip joint profile after THA, eventually affecting the condition of knee joints.…”