“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

Abstract

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.

Previous cartilage surgery is associated with inferior patient‐reported outcomes after knee arthroplasty

“…In a recent review by Olsen et al [28], preoperative pain catastrophizing was associated with worse pain in knee arthroplasty patients. Furthermore, Sellevold et al [29] found preoperative duration of pain and psychological stress to be associated with less improvement after knee arthroplasty surgery. The cartilage cohort might have experienced a longer duration of knee pain prior to the knee arthroplasty than the control group.…”