Assessment of postoperative health functioning after knee arthroplasty in relation to pain catastrophizing: a 6-month follow-up cohort study

Abstract

Background Knee arthroplasty (KA) is a typically successful surgical procedure commonly performed to alleviate painin participants with end-stage knee osteoarthritis. Despite its beneficial effects, a significant proportion of individuals with KA continue experiencing persistent pain and functional limitations. The purpose of this study was to assess the postoperative outcomes after KA in relation to postoperative pain catastrophizing. Methods Participants were recruited at a domiciliary physiotherapy service, using a prospective, observational, hypothesis-generating cohort design. Participants were divided into two groups based on their Pain Catastrophizing Scale (PCS) total score (50th percentile), which resulted in high and low PCS groups. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). In addition, quality of life, walking speed, physical performance, range of motion, and pain were measured. Outcome measures were collected at baseline (1 week postoperatively) and at follow-up (1, 3, and 6 months postoperatively). Results A total of 60 participants (21 total KA and 39 unicompartmental KA) were recruited. Individuals with a higher degree of pain catastrophizing showed significantly higher WOMAC total scores at every follow-up, indicating poorer health functioning (p < 0.01). Similarly, the high PCS group showed higher WOMAC pain, stiffness and disability subscale scores (p < 0.05), poorer quality of life (p < 0.01), and poorer physical performance (p < 0.05) at every follow-up. In addition, the high PCS group achieved a slower walking speed at baseline and at 3 months follow-up (p < 0.05), and a higher degree of pain at rest, on walking and on knee flexion at every follow-up (p < 0.01, p < 0.05 and p < 0.05, respectively) except for walking pain at 3 months follow-up. No significant differences were observed between groups in range of motion, except for active knee extension at the 6-month follow-up (p < 0.05). Effect size was large at 1 month follow-up in WOMAC total score (r = 0.578) and pain intensity during knee flexion (r = 0.529). Longitudinal analyses revealed different improvement trends during the rehabilitation process between groups, with a lack of significant improvements in the high PCS group between the 3- and 6-month follow-up in WOMAC total score, WOMAC pain, WOMAC disability, quality of life, physical performance, active knee extension and resting pain (p > 0.05). Conclusion The results of the present study suggest that participants with high postoperative pain catastrophizing might have poorer outcomes during the rehabilitation process after KA. Future work should seek to clarify if this relationship is causal.

Are Psychosocial Factors Predictors of Pain and Functional Outcomes After Knee Arthroplasty at 6 and 12 Months After Surgery? A Systematic Review

“…Only 1 study failed to provide the mean age of the sample. 10 Eighteen studies limited the inclusion to subjects with a primary diagnosis of KOA, 4,6,[11][12][13][15][16][17][28][29][30][31]33,[35][36][37][38] whereas 2 studies did not provide the primary diagnosis, 9,32,34 and another study also included patients with other conditions, such as rheumatoid arthritis. 10 One study also included subjects with unilateral knee arthroplasty and total knee arthroplasty and compared both groups.…”

“…10 One study also included subjects with unilateral knee arthroplasty and total knee arthroplasty and compared both groups. 37…”

“…11,17,29,34,35 However, there is strong evidence that catastrophizing is associated with postoperative pain (n = 1565). 6,11,13,28,30,32,33,[35][36][37] With regard to catastrophizing as a predictor of functional outcomes, there is moderate evidence that supports it (n = 282) 13,36 but limited evidence that concludes that catastrophizing is not a predictor of functionality (n = 260). 17 However, there is strong evidence that catastrophizing is associated with postoperative functional outcomes (n = 735).…”

“…17 However, there is strong evidence that catastrophizing is associated with postoperative functional outcomes (n = 735). 13,17,28,36,37…”

Electroacupuncture as an Adjuvant Approach to Rehabilitation during Postacute Phase after Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Despite its beneficial effects, most patients continue experiencing persistent moderate/severe pain and functional limitations after TKA [ 2 ]. As is reported, patients with high postoperative pain present poorer outcomes including quality of life and function during the rehabilitation process after TKA [ 3 ].…”