Longitudinal Postoperative Course of Pain and Dysfunction Following Total Knee Arthroplasty

Hadlandsmyth, Katherine; Zimmerman, M. Bridget; Wajid, Roohina; Sluka, Kathleen A.; Herr, Keela; Clark, Charles R.; Noiseux, Nicolas; Callaghan, John J.; Rakel, Barbara A.

doi:10.1097/ajp.0000000000000540

Cited by 13 publications

(8 citation statements)

References 34 publications

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“…However, the 3-month time point was chosen because patient outcomes at this time are strongly correlated with maximum recovery achieved, and it has been suggested that this may be a critical time in the recovery process (24)(25)(26)41). While some improvement in symptoms can continue during the 3-to 12-month period, studies have reported that the extent of improvements differ little across various considered subgroupings of patients, including for women and men (21,25,(42)(43)(44)(45)(46). Therefore, while it is unlikely that similar sex-specific effects that were demonstrated in the present study would not be observed over the longer term, further investigation is warranted.…”

Section: Low Back Pain -Nomentioning

confidence: 99%

Sex‐Modified Effects of Depression, Low Back Pain, and Comorbidities on Pain After Total Knee Arthroplasty for Osteoarthritis

Perruccio

Fitzpatrick

Power

et al. 2020

Arthritis Care & Research

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Objective. The influence of sex on post-total knee arthroplasty (TKA) outcomes has been variable in the literature. Though sex is often reported as an averaged effect, we undertook this study to investigate whether sex modified the influence of presurgery characteristics on post-TKA knee pain.Methods. This was a prospective study with data derived from 477 TKA osteoarthritis patients (279 women, 198 men). Questionnaires were completed presurgery and at 3 months postsurgery. The association between 3-month post-TKA knee pain and presurgery covariates (body mass index, comorbidity count, symptomatic joint count, low back pain, knee pain, and depressive symptoms) was assessed by linear regression. Sex-specific effects were evaluated using interactions.Results. Women had significantly worse presurgery knee pain, joint count, and depressive symptoms, and worse postsurgery knee pain, than men. With simple covariate adjustment, no sex effect on pain was found. However, sex was found to moderate the effects of comorbidities (worse for women [P = 0.013]), presence of low back pain (worse for men [P = 0.003]), and depressive symptoms (worse for men [P < 0.001]) on postsurgery pain. Worse presurgery pain was associated with worse postsurgery pain similarly for women and men.Conclusion. The influence of some patient factors on early post-TKA pain cannot be assumed to be the same for women and men; average effects may mask underlying associations. Results suggest a need to consider sex differences in understanding TKA outcomes, which may have important implications for prognostic tool development in TKA.

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Section: Low Back Pain -Nomentioning

confidence: 99%

Sex‐Modified Effects of Depression, Low Back Pain, and Comorbidities on Pain After Total Knee Arthroplasty for Osteoarthritis

Perruccio

Fitzpatrick

Power

et al. 2020

Arthritis Care & Research

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“…Total knee arthroplasty (TKA) is one of the most popular treatments for chronic refractory knee pain and loss of function caused by different underlying knee disorders [1]. Total knee arthroplasty is associated with serious postoperative pain, and many patients report moderate to severe pain even past the anticipated recovery period, which is a major problem that surgeons need to address [2,3]. Inadequate postoperative pain management can lead to acute effects, including immune system suppression, decreased mobility, and increased risk for deep vein thrombosis and pulmonary embolism [4,5].…”

Section: Introductionmentioning

confidence: 99%

Comparison between local infiltration analgesia with combined femoral and sciatic nerve block for pain management after total knee arthroplasty

et al. 2020

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Background: Total knee arthroplasty (TKA) is usually associated with moderate to severe postoperative pain. Peripheral nerve block (PNB) and local infiltration analgesia (LIA) are two major methods for postoperative analgesia. Femoral nerve block (FNB) leads to residual posterior knee pain; thus, currently sciatic nerve block (SNB) and LIA are two major options for supplementing FNB. However, the efficacy and safety of LIA compared with combined femoral and sciatic nerve block still remain controversial. Here, we conducted a study to analyze the postoperative analgesic efficacy of these two methods. Method: Two hundred six patients undergoing TKA were enrolled in a retrospective cohort study. The patients received either PNB or LIA. All patients in PNB group were conducted combined femoral and sciatic nerve block. All patients were encouraged to use patient-controlled analgesia (PCA) after surgery. The postoperative visual analog scale (VAS) at rest or with movement during the first 24 h and 48 h was recorded. We analyzed the VAS of 24 h, VAS of 48 h, opioid consumption, and adverse effects between PNB group and LIA group. Chi-square test and nonparametric test were used in this study. Results: There were 82 patients in the PNB group and 124 patients in the LIA group. The patients' characteristics such as age, height, weight, and ASA showed no significant difference (P > 0.05). No significant differences were found (P > 0.05) between the two groups regarding VAS score at rest or with movement. The LIA group had less opioid consumption than the PNB group but without significant difference (P > 0.05). In both groups, the most common side effect was nausea, and the side effects showed no significant differences between groups (P > 0.05). Conclusion: Local infiltration analgesia provided a similar analgesic effect and complications compared with combined femoral and sciatic nerve block in the short term. Considering less opioid consumption with local infiltration analgesia though without significant difference and its convenience, local infiltration analgesia provided better postoperative analgesia.

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“…The clinical focus has moved away from implant survival to patient-reported outcomes. The focus of scientific evaluation begins to concentrate on a patient’s experience and level of satisfaction after TKA and not only on objective outcome parameters [ 1 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although pain levels and joint flexibility are to be improved after surgery, 20 to 30% are not satisfied with the result [ 7 , 38 ]. These patients do not achieve significant symptomatic enhancement or their impairments in ADLs become even worse [ 21 ]. In their review, Canovas and Dagneaux [ 7 ] highlighted the ability of walking down the stairs as an important factor contributing to patients’ satisfaction after TKA.…”

Section: Introductionmentioning

confidence: 99%

Preoperative exercise in patients undergoing total knee arthroplasty: a pilot randomized controlled trial

et al. 2020

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Background The purpose of this study was to assess the effect of preoperative physiotherapy (PT) on functional, subjective and socio-economic parameters after total knee arthroplasty (TKA). Methods 20 patients (mean ± SD: age 67 ± 7 years) scheduled for TKA at Balgrist University Hospital between July 2016 and March 2017 were randomly assigned to a control (CG) or intervention (IG) group. 3 to 4 weeks prior to surgery the IG completed 5 to 9 sessions of PT containing proprioceptive neuromuscular facilitation (PNF) techniques, endurance training and individually indicated interventions. Measurements were executed at baseline, preoperative and 3 months after TKA. The primary outcome measure was the Stair Climbing Test (SCT), secondary outcome measures were the knee range of motion (ROM) and the level of physical activity using Lysholm Score (LS) and Tegner Activity Scale (TAS). The subjective and socio-economic parameters were the Patients’ Global Impression of Change (PGIC) scale, inpatient rehabilitation time, preoperative pain levels and metabolic equivalent (MET), postoperative intake of analgesics and overall costs. Results No difference between IG and CG was found for SCT (F (2/36) = 0.016, p = 0.984, η2 = 0.004). An interaction between group and time was shown for TAS (F (18/1) = 13.890) with an increase in the IG ( p = 0.002, η2 = 0.536). The sub-item “pain” within the LS presented a higher pain-level in CG (F (18/1) = 4.490, p = 0.048, η2 = 0.974), while IG showed a higher preoperative MET compared to CG ( p = 0.035). There were no other significant changes. The CG produced 21.4% higher overall costs, took more analgesics and showed higher preoperative pain levels than the IG. Conclusions Findings show that preoperative therapy improved the level of physical activity before and after TKA and resulted in a clinically relevant gain in TAS. Trial registration ClinicalTrials.gov Identifier; NCT03160534 . Registered 19 May 2017

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Longitudinal Postoperative Course of Pain and Dysfunction Following Total Knee Arthroplasty

Abstract: These findings demonstrate that the majority of patients' pain and functioning remains stable between 6 weeks and 6 months post-TKA. However, a notable subset continues to improve or worsen in pain and functioning and the current study identifies variables associated with these changes.

Cited by 13 publications

References 34 publications

Sex‐Modified Effects of Depression, Low Back Pain, and Comorbidities on Pain After Total Knee Arthroplasty for Osteoarthritis

Sex‐Modified Effects of Depression, Low Back Pain, and Comorbidities on Pain After Total Knee Arthroplasty for Osteoarthritis

Comparison between local infiltration analgesia with combined femoral and sciatic nerve block for pain management after total knee arthroplasty

Preoperative exercise in patients undergoing total knee arthroplasty: a pilot randomized controlled trial

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