Changes in social isolation and loneliness following total hip and knee arthroplasty: longitudinal analysis of the English Longitudinal Study of Ageing (ELSA) cohort

Smith, Toby; Dainty, J.; Macgregor, Alexander

doi:10.1016/j.joca.2017.04.003

Cited by 16 publications

(17 citation statements)

References 33 publications

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“… 28 - 32 Older people with chronic pain after joint arthroplasty can experience interference with relationships and become socially isolated, which is a risk factor for other problems and can limit their capacity to bring about change or to seek help for their pain. 31 , 33 , 34 Some people experience considerable pain-related distress, and this is often highest in those who experience no change or deterioration in pain symptoms following surgery. 35 Pain relief is the main expectation of patients undergoing TKA, 36 and those who have continuing pain are often the most dissatisfied and disappointed with the outcome of their surgery.…”

Section: Personal and Economic Impactmentioning

confidence: 99%

Chronic pain after total knee arthroplasty

Wylde¹,

et al. 2018

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Despite a good outcome for many patients, approximately 20% of patients experience chronic pain after total knee arthroplasty (TKA).Chronic pain after TKA can affect all dimensions of health-related quality of life, and is associated with functional limitations, pain-related distress, depression, poorer general health and social isolation.In both clinical and research settings, the approach to assessing chronic pain after TKA needs to be in-depth and multidimensional to understand the characteristics and impact of this pain. Assessment of this pain has been inadequate in the past, but there are encouraging trends for increased use of validated patient-reported outcome measures.Risk factors for chronic pain after TKA can be considered as those present before surgery, intraoperatively or in the acute postoperative period. Knowledge of risk factors is important to guide the development of interventions and to help to target care. Evaluations of preoperative interventions which optimize pain management and general health around the time of surgery are needed.The causes of chronic pain after TKA are not yet fully understood, although research interest is growing and it is evident that this pain has a multifactorial aetiology, with a wide range of possible biological, surgical and psychosocial factors that can influence pain outcomes.Treatment of chronic pain after TKA is challenging, and evaluation of combined treatments and individually targeted treatments matched to patient characteristics is advocated. To ensure that optimal care is provided to patients, the clinical- and cost-effectiveness of multidisciplinary and individualized interventions should be evaluated.Cite this article: EFORT Open Rev 2018;3:461-470. DOI: 10.1302/2058-5241.3.180004

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Section: Personal and Economic Impactmentioning

confidence: 99%

Chronic pain after total knee arthroplasty

Wylde¹,

et al. 2018

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“…For example, according to patient-reported outcomes (PROMs), the overall result is generally positive, although discrepancies are seen when PROMs are compared to performance-based function (Luna et al 2017 , Stevens-Lapsley et al 2011 ). Also, postoperative activity levels are disappointingly low in many patients, and around 20% of patients are socially isolated following surgery (Harding et al 2014 ; Smith et al 2017 ). Additionally, about 5 to 20% of all patients report chronic pain after THA and TKA, respectively (Beswick et al 2012 ).…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation strategies for optimisation of functional recovery after major joint replacement

2018

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Exercise-based interventions applied before and after total hip and knee arthroplasty (THA and TKA, respectively) have been investigated for a number of years, based on the assumption that they will enhance post-operative recovery. Although recent studies suggest that high-volume, pre-operative exercise may enhance post-operative recovery after TKA, studies of post-operative exercise-based interventions, have not found superiority of one exercise regime over another. It seems, however, that post-operative, exercise-based, rehabilitation is superior to no or minimal rehabilitation after THA and TKA.The goal of this commentary is to summarize recent evidence for the efficacy of different peri-operative exercise-based interventions to enhance recovery after THA and TKA, and to propose new strategies to further enhance post-operative recovery.There is a major need to improve functional recovery after THA and TKA. We propose a strategy of “enriched” trials where specific rehabilitation interventions are applied to different patients based on, for example, their expectations for post-operative recovery, willingness to undertake exercise and physical activity, and pre-operative functional performance.

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“…With approximately 700,000 KR performed per year in the US [ 3 ] and 108,000 performed during 2016 in England, Wales, Northern Ireland and the Isle of Man [ 4 ], large numbers of people are living with chronic pain after KR. These patients experience high levels of pain-related distress [ 5 ] and reduced ability to participate in work, family life and valued social activities, which may contribute to social isolation [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Identifying individuals with chronic pain after knee replacement: a population-cohort, cluster-analysis of Oxford knee scores in 128,145 patients from the English National Health Service

Pinedo-Villanueva

Khalid

Wylde

et al. 2018

BMC Musculoskelet Disord

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BackgroundApproximately one in five patients undergoing knee replacement surgery experience chronic pain after their operation, which can negatively impact on their quality of life. In order to develop and evaluate interventions to improve the management of chronic post-surgical pain, we aimed to derive a cut-off point in the Oxford Knee Score pain subscale to identify patients with chronic pain following knee replacement, and to characterise these patients using self-reported outcomes.MethodsData from the English Patient-Reported Outcome Measures (PROMs) programme were used. This comprised patient-reported data from 128,145 patients who underwent primary knee replacement surgery in England between 2012 and 2015. Cluster analysis was applied to derive a cut-off point on the pain subscale of the Oxford Knee Score.ResultsA high-pain group was identified, described by a maximum of 14 points in the Oxford Knee Score pain subscale six months after surgery. The high-pain group, comprising 15% of the sample, was characterised by severe and frequent problems in all pain dimensions, particularly in pain severity, night pain and limping, as well as in all dimensions of health-related quality of life.ConclusionsPatients with Oxford Knee Score pain subscale scores of 14 or less at six months after knee replacement can be considered to be in chronic pain that is likely to negatively affect their quality of life. This derived cut-off can be used for patient selection in research settings to design and assess interventions that support patients in their management of chronic post-surgical pain.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2270-9) contains supplementary material, which is available to authorized users.

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Changes in social isolation and loneliness following total hip and knee arthroplasty: longitudinal analysis of the English Longitudinal Study of Ageing (ELSA) cohort

Cited by 16 publications

References 33 publications

Chronic pain after total knee arthroplasty

Chronic pain after total knee arthroplasty

Rehabilitation strategies for optimisation of functional recovery after major joint replacement

Identifying individuals with chronic pain after knee replacement: a population-cohort, cluster-analysis of Oxford knee scores in 128,145 patients from the English National Health Service

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