Risk Assessment for Chronic Pain and Patient Satisfaction After Total Knee Arthroplasty

Abstract

The estimated prevalence of patients who report minor or no improvement of their symptoms and pain after total knee arthroplasty (TKA) remains high, ranging from 5% to 40%. The authors sought to determine whether chronic pain and functional health are related to specific variations in demographic data, surgical techniques, or radiographic pre- and postoperative findings. They also sought to identify independent risk factors for persistent moderate-to-severe chronic pain after TKA. A total of 273 patients who underwent primary TKA from October 2007 to March 2010 with a minimum follow-up of 1 year were identified from electronic medical records. A questionnaire to identify persistent postoperative pain (36-item Short Form Health Survey [SF-36]) was mailed to these patients. Linear regression and logistic regression were used to identify predictors for SF-36 and chronic pain, respectively. Thirty-nine percent of patients reported persistent pain after TKA, with a median average pain score of 3 out of 10 and worst pain score of 5 out of 10. Independent risk factors for persistent pain are the length of the operative procedure (odds ratio [OR]=1.013), medical history of diabetes mellitus (OR=0.430), presence of preoperative flexion contracture (OR=1.089), and patellofemoral joint overstuffing (OR=0.915). Persistent postoperative pain is a common finding after TKA. Nonmodifiable risk factors could be used for risk stratification, whereas modifiable risk factors could be used as a clinical guidance for modification of some aspects of existing surgical techniques.

Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty

“…Despite the surgical success of total knee arthroplasty (TKA), about 20 % of all patients are dissatisfied [ 27 ]. Numerous studies suggest that a suboptimal post-operative result is associated with chronic knee pain and lower than expected function [ 21 , 22 , 26 ]. Others attribute patient-related factors such as gender (being female), a higher body mass index and depression to an increased risk of post-operative pain and stiffness [ 8 ].…”

Chondrocyte Viability at Time of Transplantation for Osteochondral Allografts Preserved by the Missouri Osteochondral Preservation System versus Standard Tissue Bank Protocol

“…2,3 However, in patients younger than 55 who wish to remain active, traditional artificial knee arthroplasty is not as successful based on pain, complications, morbidity, level of activity, and likelihood for revision. [2][3][4][5][6][7][8][9][10][11] Based on less successful outcomes after primary knee arthroplasty in conjunction with the diminishing outcomes associated with revision arthroplasties, patients under 55 are not considered ideal candidates for traditional knee arthroplasty surgeries.…”

A Prospective Study on Total Knee Arthroplasty Outcomes in North of Iran

“…With decrease in joint motion, the muscles become weak and will no longer be able to protect the joint. (24,25) Therefore, pain is one of the principle indications for total knee arthroplasty. In this research, score of patients' pain had a significant decrease over the postoperative follow-up period and they were satisfied.…”