Progression of chronic pain and associated health-related quality of life and healthcare resource use over 5 years after total knee replacement: evidence from a cohort study

Cole, Sophie; Kolovos, Spyros; Soni, Anushka; Delmestri, Antonella; Sanchez‐Santos, Maria T; Judge, Andrew; Arden, N K; Beswick, Andrew D; Wylde, Vikki; Gooberman-Hill, Rachael; Pinedo-Villanueva, Rafael

doi:10.1136/bmjopen-2021-058044

Cited by 14 publications

(20 citation statements)

References 44 publications

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“…Studies have raised the issue of the bidirectional relationship between pain and sleep [ 40 ]. In line with a previous study [ 41 ], our participants with excessive preoperative pain seemed to experience a cycle of pain and deteriorating health. In addition, poor preoperative sleep quality has been shown to have a negative impact on PPP [ 42 ].…”

Section: Discussionsupporting

confidence: 89%

“I am accustomed to something in my body causing pain”: a qualitative study of knee replacement non-improvers’ stories of previous painful and stressful experiences

Sellevold

Olsen

Lindberg

et al. 2023

BMC Musculoskelet Disord

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Background Approximately 20% of total knee arthroplasty patients experience persistent postsurgical pain one year after surgery. No qualitative studies have explored previous stories of painful or stressful life experiences in patients experiencing persistent postsurgical pain after total knee replacement. This study aimed to explore stories of previous painful or stressful experiences in life in a cohort of patients that reported no improvement in pain one year after total knee arthroplasty. Methods The study employed an explorative-descriptive qualitative design. Data was collected through semi-structured interviews five to seven years after surgery, with patients who reported no improvement in pain-related interference with walking 12 months after total knee replacement. The data was analyzed using qualitative content analysis. Results The sample consisted of 13 women and 10 men with a median age of 67 years at the time of surgery. Prior to surgery, six reported having at least one chronic illness and 16 reported having two or more painful sites. Two main themes were identified in the data analysis: Painful years - the burden of living with long lasting pain, and the burden of living with psychological distress. Conclusions The participants had severe longlasting knee pain as well as longlasting pain in other locations, in addition to experiences of psychologically stressful life events before surgery. Health personnel needs to address the experience and perception of pain and psychological struggles, and how it influences patients’ everyday life including sleeping routines, work- and family life as well as to identify possible vulnerability for persistent postsurgical pain. Identifying and assessing the challenges enables personalized care and support, such as advice on pain management, cognitive support, guided rehabilitation, and coping strategies both pre-and post-surgery.

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Section: Discussionsupporting

confidence: 89%

“I am accustomed to something in my body causing pain”: a qualitative study of knee replacement non-improvers’ stories of previous painful and stressful experiences

Sellevold

Olsen

Lindberg

et al. 2023

BMC Musculoskelet Disord

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“…The higher healthcare expenditures in adults with osteoarthritis and pain may be due to chronic pain that may lead to increased utilization of health care resources such as frequent use of outpatient services, pharmacy, and increased emergency department visits. 45,46 This study expanded the previous literature, by determining which of the differences in characteristics contributed to the excess expenditures associated with pain among adults with osteoarthritis using decomposition analysis. In decomposition analysis, we found that nearly two-thirds of the difference in direct healthcare expenditures was explained by differences in predisposing, enabling, need lifestyle, and environmental factors between those with and without pain.…”

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

A Linear Decomposition Approach to Explain Excess Direct Healthcare Expenditures Associated with Pain Among Adults with Osteoarthritis

Ikram

Shaikh

Sambamoorthi

2022

Health�Serv�Insights

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Objective: Many patients with osteoarthritis experience pain which can lead to higher healthcare expenditures. It is important to understand the factors that drive the excess expenditures associated with pain in osteoarthritis. Design: Cross-sectional. Study sample: Our study sample consisted of adults (age ⩾ 18 years) from the Medical Expenditure Panel Survey (MEPS, 2018). Methods: Adults who were alive during the calendar year and had pain status were included in this study (N = 2804 weighted N = 32.03 million). Osteoarthritis was identified from the medical conditions file and household file. We used multivariable ordinary least squares regression to identify the statistically significant association of pain with direct healthcare expenditures. The Blinder-Oaxaca post-linear decomposition on log-transformed total direct healthcare expenditures was used to estimate the extent to which differences in characteristics contribute to the excess expenditures associated with pain. Results: Adults with osteoarthritis and pain had higher average expenditures ($21 814 vs $10 827, P < .001; 9.318 vs 8.538 in logtransformed expenditures) compared to those without pain. Pooled regression weights explained 62.9% of excess expenditures differences in characteristics between the 2 groups. The 2 main drivers of excess healthcare expenditures among adults with osteoarthritis and pain were (i) comorbidities (diabetes, asthma, chronic obstructive pulmonary disease, depression, heart diseases, cancer, and non-cancer pain conditions and (ii) prescription medications (NSAIDs, opioids, and polypharmacy). Conclusion: Need factors such as comorbid conditions, and prescription treatment explained the excess healthcare expenditures among adults with osteoarthritis and pain. The study findings suggest that reducing polypharmacy and appropriate management of comorbid conditions may be a pathway to reduce excess expenditures among adults with osteoarthritis and pain.

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“…The Support and Treatment After Replacement (STAR) care pathway was found to be more clinically effective and cost-effective than usual care for patients with persistent pain at 3 months following pTKA 40 . The natural history of pain following pTKA also appears to be one of improvement over time, with 1 study demonstrating that two-thirds of patients recovered during the first 4 years postoperatively 41 . As such, we caution against early rTKA for unexplained pain.…”

Section: Discussionmentioning

confidence: 99%

Patient-Relevant Outcomes Following First Revision Total Knee Arthroplasty, by Diagnosis

Sabah,

Knight,

Alvand

et al. 2023

Journal of Bone and Joint Surgery

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Background: The purpose of this study was to investigate patient-relevant outcomes following first revision total knee arthroplasties (rTKAs) performed for different indications. Methods: This population-based cohort study utilized data from the United Kingdom National Joint Registry, Hospital Episode Statistics Admitted Patient Care, National Health Service Patient-Reported Outcome Measures, and the Civil Registrations of Death. Patients undergoing a first rTKA between January 1, 2009, and June 30, 2019, were included in our data set. Patient-relevant outcomes included implant survivorship (up to 11 years postoperatively), mortality and serious medical complications (up to 90 days postoperatively), and patient-reported outcome measures (at 6 months postoperatively). Results: A total of 24,540 first rTKAs were analyzed. The patient population was 54% female and 62% White, with a mean age at the first rTKA of 69 years. At 2 years postoperatively, the cumulative incidence of re-revision surgery ranged from 2.7% (95% confidence interval [CI], 1.9% to 3.4%) following rTKA for progressive arthritis to 16.3% (95% CI, 15.2% to 17.4%) following rTKA for infection. The mortality rate at 90 days was highest following rTKA for fracture (3.6% [95% CI, 2.5% to 5.1%]) and for infection (1.8% [95% CI, 1.5% to 2.2%]) but was <0.5% for other indications. The rate of serious medical complications requiring hospital admission within 90 days was highest for patients treated for fracture (21.8% [95% CI, 17.9% to 26.3%]) or infection (12.5% [95% CI, 11.2% to 13.9%]) and was lowest for those treated for progressive arthritis (4.3% [95% CI, 3.3% to 5.5%]). Patients who underwent rTKA for stiffness or unexplained pain had some of the poorest postoperative joint function (mean Oxford Knee Score, 24 and 25 points, respectively) and had the lowest proportion of responders (48% and 55%, respectively). Conclusions: This study found large differences in patient-relevant outcomes among different indications for first rTKA. The rate of complications was highest following rTKA for fracture or infection. Although rTKA resulted in large improvements in joint function for most patients, those who underwent surgery for stiffness and unexplained pain had worse outcomes. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Progression of chronic pain and associated health-related quality of life and healthcare resource use over 5 years after total knee replacement: evidence from a cohort study

Cited by 14 publications

References 44 publications

“I am accustomed to something in my body causing pain”: a qualitative study of knee replacement non-improvers’ stories of previous painful and stressful experiences

“I am accustomed to something in my body causing pain”: a qualitative study of knee replacement non-improvers’ stories of previous painful and stressful experiences

A Linear Decomposition Approach to Explain Excess Direct Healthcare Expenditures Associated with Pain Among Adults with Osteoarthritis

Patient-Relevant Outcomes Following First Revision Total Knee Arthroplasty, by Diagnosis

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