Chronic postsurgical pain after total knee arthroplasty: A prospective cohort study in Japanese population

Aso, Koji; Ikeuchi, Masahiko; Takaya, Shogo; Sugimura, Natsuki; Izumi, Masashi; Wada, Hiroyuki; Okanoue, Yusuke; Dan, Junpei

doi:10.1080/14397595.2020.1859709

Cited by 17 publications

(13 citation statements)

References 29 publications

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“…Pain catastrophizing describes an amplified emotional and cognitive response to pain 23,24 , and is a stronger predictor of pain intensity in urgent care settings than vital signs 25,26 . In addition to pain catastrophizing, presurgical opioid use 27,28 , severe presurgical pain intensity [29][30][31] , and patients' outcome expectations 32 are modifiable factors associated with postsurgical outcomes. Given the mixed results of biomedical interventions (e.g., procedures and analgesic drug prescriptions) in reducing the risk of unresolved chronic pain 21,33 , assessment and evaluation of modifiable biopsychosocial factors provides one avenue for improving patient-centered interventions and postsurgical outcomes.…”

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confidence: 99%

Pain Catastrophizing Predicts Opioid and Health-Care Utilization After Orthopaedic Surgery

Rhon

Greenlee

Carreño

et al. 2022

Journal of Bone and Joint Surgery

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Background:Most individuals undergoing elective surgery expect to discontinue opioid use after surgery, but many do not. Modifiable risk factors including psychosocial factors are associated with poor postsurgical outcomes. We wanted to know whether pain catastrophizing is specifically associated with postsurgical opioid and health-care use.Methods:This was a longitudinal cohort study of trial participants undergoing elective spine (lumbar or cervical) or lower-extremity (hip or knee osteoarthritis) surgery between 2015 and 2018. Primary and secondary outcomes were 12-month postsurgical days’ supply of opioids and surgery-related health-care utilization, respectively. Self-reported and medical record data included presurgical Pain Catastrophizing Scale (PCS) scores, surgical success expectations, opioid use, and pain interference duration.Results:Complete outcomes were analyzed for 240 participants with a median age of 42 years (34% were female, and 56% were active-duty military service members). In the multivariable generalized additive model, greater presurgical days’ supply of opioids (F = 17.23, p < 0.001), higher pain catastrophizing (F = 1.89, p = 0.004), spine versus lower-extremity surgery (coefficient estimate = 1.66 [95% confidence interval (CI), 0.50 to 2.82]; p = 0.005), and female relative to male sex (coefficient estimate = −1.25 [95% CI, −2.38 to −0.12]; p = 0.03) were associated with greater 12-month postsurgical days’ supply of opioids. Presurgical opioid days’ supply (chi-square = 111.95; p < 0.001), pain catastrophizing (chi-square = 96.06; p < 0.001), and lower extremity surgery (coefficient estimate = −0.17 [95% CI, −0.24 to −0.11]; p < 0.001), in addition to age (chi-square = 344.60; p < 0.001), expected recovery after surgery (chi-square = 54.44; p < 0.001), active-duty status (coefficient estimate = 0.58 [95% CI, 0.49 to 0.67]; p < 0.001), and pain interference duration (chi-square = 43.47; p < 0.001) were associated with greater health-care utilization.Conclusions:Greater presurgical days’ supply of opioids and pain catastrophizing accounted for greater postsurgical days’ supply of opioids and health-care utilization. Consideration of several modifiable factors provides an opportunity to improve postsurgical outcomes.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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confidence: 99%

Pain Catastrophizing Predicts Opioid and Health-Care Utilization After Orthopaedic Surgery

Rhon

Greenlee

Carreño

et al. 2022

Journal of Bone and Joint Surgery

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“…Although TKA surgery has been regarded as a successful treatment option for restoring function and for alleviating pain in the treatment of knee joint disease, approximately 20% of these cases have little or no improvement in physical function, pain and quality of life 20,21 . Many risk factors, such as the female sex, age, alcohol use, smoking, pre‐existing psychiatric illness and the African‐American race, are associated with increased persistent pain and increased patient dissatisfaction after TKA 22,23 . Among these risk factors, precise bone resection and accurate component positioning are important for preventing the malalignment of TKA 24,25 .…”

Section: Discussionmentioning

confidence: 99%

“…20,21 Many risk factors, such as the female sex, age, alcohol use, smoking, pre-existing psychiatric illness and the African-American race, are associated with increased persistent pain and increased patient dissatisfaction after TKA. 22,23 Among these risk factors, precise bone resection and accurate component positioning are important for preventing the malalignment of TKA. 24,25 Inadequate bone resection may cause suboptimal component positioning, thus leading to malalignment, which can result in an increased rate of revision arthroplasty and polyethylene wear.…”

Section: F I G U R E 4 Typical Picture Of Sawbones After Bone Resection: (A) Femoral; (B) Tibialmentioning

confidence: 99%

Better precision of a new robotically assisted system for total knee arthroplasty compared to conventional techniques: A sawbone model study

Chen

Zhang

et al. 2021

Robotics Computer Surgery

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Background The purpose of this study was to compare the accuracy of this new HURWA robotic‐assisted total knee arthroplasty (TKA) technique to the accuracy of the conventional technique in a sawbone model. Methods The HURWA robotic‐assisted TKA system was applied in the robotic group. After bone resection, all of these sawbones were scanned by the use of a structured light scanning system. Measurements of bone resections, femoral coronal and sagittal measurements, and tibial coronal and sagittal measurements were recorded. Results Compared to the conventional technique, the HURWA robotic‐assisted system significantly improved the accuracy of the bone resection levels and angles. In the robotic group, the accuracy of all of the bone resection levels was below 0.6 mm (with standard deviation [SD] below 0.6 mm), and all of the bone resection angles were below 0.6° (with SD below 0.4°). Conclusion Our data suggest that this novel HURWA robotic‐assisted system can significantly improve the accuracy of bone resection levels and angles.

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“…Because this study aimed to analyze factors associated with PPSP (from both prospective and retrospective studies), an alternative method for the ROB systematic assessment was applied based on the methodology used in other systematic reviews focusing on the analysis of predicting factors. 53,56,116 Potential sources of bias were evaluated and addressed whether (1) the sample adequately represented the population of interest, (2) the data represented the sample, and (3) the outcome of interest was adequately measured to limit potential bias (Appendix 2, available at http://links.lww.com/ PR9/A184). Other potential serious sources of bias were documented-eg, selective reporting of outcomes, use of nonvalidated scales, or lack or inappropriateness of sample size calculation.…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

Factors associated with persistent postsurgical pain after total knee or hip joint replacement: a systematic review and meta-analysis

Ghoshal

Bhanvadia

Singh

et al. 2023

PR9

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Studies have identified demographic, clinical, psychosocial, and perioperative variables associated with persistent pain after a variety of surgeries. This study aimed to perform a systematic review and meta-analysis of factors associated with persistent pain after total knee replacement (TKR) and total hip replacement (THR) surgeries. To meet the inclusion criteria, studies were required to assess variables before or at the time of surgery, include a persistent postsurgical pain (PPSP) outcome measure at least 2 months after a TKR or THR surgery, and include a statistical analysis of the effect of the risk factor(s) on the outcome measure. Outcomes from studies implementing univariate and multivariable statistical models were analyzed separately. Where possible, data from univariate analyses on the same factors were combined in a meta-analysis. Eighty-one studies involving 171,354 patients were included in the review. Because of the heterogeneity of assessment methods, only 44% of the studies allowed meaningful meta-analysis. In meta-analyses, state anxiety (but not trait anxiety) scores and higher depression scores on the Beck Depression Inventory were associated with an increased risk of PPSP after TKR. In the qualitative summary of multivariable analyses, higher preoperative pain scores were associated with PPSP after TKR or THR. This review systematically assessed factors associated with an increased risk of PPSP after TKR and THR and highlights current knowledge gaps that can be addressed by future research.

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Chronic postsurgical pain after total knee arthroplasty: A prospective cohort study in Japanese population

Cited by 17 publications

References 29 publications

Pain Catastrophizing Predicts Opioid and Health-Care Utilization After Orthopaedic Surgery

Pain Catastrophizing Predicts Opioid and Health-Care Utilization After Orthopaedic Surgery

Better precision of a new robotically assisted system for total knee arthroplasty compared to conventional techniques: A sawbone model study

Factors associated with persistent postsurgical pain after total knee or hip joint replacement: a systematic review and meta-analysis

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