Factors that can predict pain with walking, 12 months after total knee arthroplasty

Lindberg, Maren Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Cooper, Bruce A.; Lerdal, Anners

doi:10.1080/17453674.2016.1237440

Cited by 42 publications

(70 citation statements)

References 47 publications

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“…Previous studies have reported associations between psychological measures and activity-related pain (Sullivan et al 2002; Swinkels-Meewisse et al 2006) including associations with treatment outcomes (Lindberg et al 2016). Indeed, multiple psychological factors in people with knee OA pain are associated with the development of disability and longer term worsening of pain (Helminen et al 2016).…”

Section: Discussionmentioning

confidence: 99%

Physical performance and movement-evoked pain profiles in community-dwelling individuals at risk for knee osteoarthritis

Cruz-Almeida

Cardoso

Riley

et al. 2017

Experimental Gerontology

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Background Knee pain associated with osteoarthritis is a significant contributor to decreased physical function. Recent evidence supports the inter-individual heterogeneity associated with knee pain presentation, but whether there is similar heterogeneity in physical performance among these individuals has not been previously examined. The aim of the present study was to characterize the variability in physical performance profiles and the pain evoked by their performance (i.e., movement-evoked pain). Methods In a secondary analysis of the community-based study Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD), individuals (n=270) completed functional, pain, psychological, and somatosensory assessments. Hierarchical cluster analysis was used to derive physical function profiles that were subsequently compared across several clinical, psychological and experimental pain measures. Results Our results support the hypothesis that among persons with knee OA pain, three different physical performance profiles exist with varying degrees of movement-evoked pain. Even as all three groups experienced moderate to severe levels of spontaneous knee pain, those individuals with the most severe movement-evoked pain and lowest physical functional performance also had the least favorable psychological characteristics along with increased mechanical pain sensitivity and temporal summation. Conclusions Our findings support the need for the assessment and consideration of movement-evoked pain during physical performance tasks as these have the potential to increase the value of functional and pain assessments clinically. The identification of the mechanisms driving pain burden within homogeneous groups of individuals will ultimately allow for targeted implementation of treatments consistent with a biopsychosocial model of pain.

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Section: Discussionmentioning

confidence: 99%

Physical performance and movement-evoked pain profiles in community-dwelling individuals at risk for knee osteoarthritis

Cruz-Almeida

Cardoso

Riley

et al. 2017

Experimental Gerontology

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“…All patients received the same posterior cruciate-retaining fixed modular-bearing implant for the TKA using an intraoperative tourniquet and with drains that were removed on POD 1. The full regimen for pain management was described in detail elsewhere [ 8 ]. Patients were allowed full weight bearing starting on POD 1 and were followed up with weekly physical therapy for 4 to 6 months after surgery.…”

Section: Methodsmentioning

confidence: 99%

“…For example, poorer self-efficacy with walking skills [ 6 ], more preoperative walking limitations, higher body mass index (BMI), slower 1 month gait speed, contralateral knee pain, and use of quadstick before surgery [ 7 ] were associated with poorer walking outcomes 6 months after TKA. Recently, our research group demonstrated that one in five patients reported no improvements in pain interference with walking 1 year after TKA [ 8 ]. In that study, pain interference with walking was measured at repeated intervals during the first year.…”

Section: Introductionmentioning

confidence: 99%

The relationship between pain with walking and self-rated health 12 months following total knee arthroplasty: a longitudinal study

Lindberg

Rustøen

Miaskowski

et al. 2017

BMC Musculoskelet Disord

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BackgroundA subgroup of patients continue to report pain with walking 12 months after total knee arthroplasty (TKA). The association between walking pain and self-rated health (SRH) after TKA is not known. This prospective longitudinal study aimed to investigate the association between a comprehensive list of preoperative factors, postoperative pain with walking, and SRH 12 months after TKA.MethodsPatients (N = 156) scheduled for TKA completed questionnaires that evaluated demographic and clinical characteristics, symptoms, psychological factors, and SRH. SRH was re-assessed 12 months after TKA. Clinical variables were retrieved from medical records. Pain with walking was assessed before surgery, at 6 weeks, 3, and 12 months after TKA. Subgroups with distinct trajectories of pain with walking over time were identified using growth mixture modeling. Multiple linear regression was used to investigate the relationships between pain with walking and other factors on SRH.ResultsHigher body mass index, a higher number of painful sites at 12 months, recurrent pain with walking group membership, ketamine use, higher depression scores, and poorer preoperative self-rated health were associated with poorer SRH 12 months after TKA. The final model was statistically significant (p = 0.005) and explained 56.1% of the variance in SRH 12 months after surgery. SRH improved significantly over time. Higher C-reactive protein levels, higher number of painful sites before surgery, higher fatigue severity, and more illness concern was associated with poorer preoperative SRH.ConclusionsIn patients whose walking ability decreases over time, clinicians need to assess for unreleaved pain and decreases in SRH. Additional research is needed on interventions to improve walking ability and SRH.

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“…Preoperative pain severity is one of the most studied risk factors, and there is strong evidence that more severe preoperative pain is associated with more severe postoperative pain. 11 , 51 , 56 , 64 , 65 Chronic pain elsewhere in the body is also associated with long-term pain after surgery, 66 suggesting that this pain may be due to an altered central modulation of pain, as part of a more generalized pain condition. 67 - 69 Poor mental health, such as symptoms of depression and anxiety, is common in patients waiting for TKA 70 and has been found to be predictive of a poorer long-term pain outcome after surgery.…”

Section: Risk Factorsmentioning

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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Factors that can predict pain with walking, 12 months after total knee arthroplasty

Cited by 42 publications

References 47 publications

Physical performance and movement-evoked pain profiles in community-dwelling individuals at risk for knee osteoarthritis

Physical performance and movement-evoked pain profiles in community-dwelling individuals at risk for knee osteoarthritis

The relationship between pain with walking and self-rated health 12 months following total knee arthroplasty: a longitudinal study

Chronic pain after total knee arthroplasty

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