Post-operative patient-related risk factors for chronic pain after total knee replacement: a systematic review

Abstract

ObjectiveTo identify postoperative patient-related risk factors for chronic pain after total knee replacement (TKR).DesignThe systematic review protocol was registered on the International Prospective Register of Systematic Reviews (CRD42016041374). MEDLINE, Embase and PsycINFO were searched from inception to October 2016 with no language restrictions. Key articles were also tracked in the Institute for Scientific Information (ISI) Web of Science. Cohort studies evaluating the association between patient-related factors in the first 3 months postoperatively and pain at 6 months or longer after primary TKR surgery were included. Screening, data extraction and assessment of methodological quality were undertaken by two reviewers. The primary outcome was pain severity in the replaced knee measured with a patient-reported outcome measure at 6 months or longer after TKR. Secondary outcomes included adverse events and other aspects of pain recommended by the core outcome set for chronic pain after TKR.ResultsAfter removal of duplicates, 16 430 articles were screened, of which 805 were considered potentially relevant. After detailed evaluation of full-text articles, 14 studies with data from 1168 participants were included. Postoperative patient-related factors included acute pain (eight studies), function (five studies) and psychosocial factors (four studies). The included studies had diverse methods for assessment of potential risk factors and outcomes, and therefore narrative synthesis was conducted. For all postoperative factors, there was insufficient evidence to draw firm conclusions about the association with chronic pain after TKR. Selection bias was a potential risk for all studies, as none were reported to be conducted at multiple centres.ConclusionThis systematic review found insufficient evidence to draw firm conclusions about the association between any postoperative patient-related factors and chronic pain after TKR. Further high-quality research is required to provide a robust evidence base on postoperative risk factors, and inform the development and evaluation of targeted interventions to optimise patients’ outcomes after TKR.

Chronic pain after total knee arthroplasty

“… 62 Post-surgical factors may be risk factors for chronic pain through limiting rehabilitation and recovery; however, a systematic review has found that there is insufficient evidence to draw firm conclusions about the association between postoperative factors and chronic pain after TKA. 80 Although acute postoperative pain is often assumed to be associated with chronic pain, and is a strong risk factor for other surgical populations, 6 there is little evidence to support this association in patients with TKA after controlling for preoperative pain severity. 56 , 81 However, ongoing work to understand the transition of acute postoperative pain to chronic pain in a surgical setting may help to inform strategies to minimize suboptimal pain outcomes after TKA.…”

Are perioperative interventions effective in preventing chronic pain after primary total knee replacement? A systematic review

“…Mechanical explanations include altered gait, prosthesis loosening and effects on ligaments 14 15. Psychological factors including depression and catastrophising may also influence outcomes 16–19. Much research has focused on preoperative predictors of outcomes and these include pain intensity, presence of widespread pain, anxiety, depression and catastrophising 10 20.…”

Effectiveness of postdischarge interventions for reducing the severity of chronic pain after total knee replacement: systematic review of randomised controlled trials

“…However, identifying high risk patients is challenging; preoperative models to identify patients at risk of a poor outcome have low predictive power, 36 37 and the evidence for postoperative risk factors is limited. 47 However, research is currently ongoing to evaluate whether providing a rehabilitation programme for patients at risk of a poor outcome 34 or are ‘functioning poorly’ at 6 weeks after TKR 35 can improve longer-term outcomes.…”