The association of pre-operative body pain diagram scores with pain outcomes following total knee arthroplasty

Abstract

Objective Approximately 20% of total knee arthroplasty (TKA) recipients have suboptimal pain relief. We evaluated the association between pre-surgical widespread body pain and incomplete pain relief following TKA. Method This prospective analysis included 241 patients with knee OA undergoing unilateral TKA who completed questionnaires preoperatively and up to 12 months post-operatively. Questionnaires included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale and a body pain diagram. We derived the number of non-index painful body regions from the diagram. We used Poisson regression to determine the association between painful body regions identified preoperatively and both WOMAC pain at follow-up and improvement in pain as defined by the minimal clinically important difference (MCID). Results Mean subject age was 66 years (SD 9), and 61% were females. Adjusting for age, sex, co-morbid conditions, baseline pain, pain catastrophizing, and mental health, we found that more widespread body pain was associated with a higher likelihood of reporting 12-month WOMAC pain score >15 (relative risk [RR] per painful body region 1.39, 95% CI 1.18–1.63) and a greater likelihood of failing to achieve the MCID (RR 1.47, 95% CI 1.16–1.86). ). Pain catastrophizing was an independent predictor of persistent pain and failure to improve by the MCID (RR 3.57, 95% CI 1.73–7.31). Conclusions Pre-operative widespread pain was associated with greater pain at 12-months and failure to reach the MCID. Widespread pain as captured by the pain diagram, along with the pain catastrophizing score, may help identify persons with suboptimal TKA outcome.

Predicting the Outcome of Total Knee Arthroplasty Using the WOMAC Score: A Review of the Literature

“…Hawker et al 20 concluded that while a single TKA might substantially improve pain if the replaced joint is the main contributor to the patient's pain experience, the presence of arthritis in other joints and/or comorbid conditions would likely attenuate the overall effect of TKA on functioning. Dave et al 21 agreed with this hypothesis, reporting that more widespread body pain was associated with a higher likelihood of reporting 12-month WOMAC pain score >15 and a greater likelihood of failing to achieve the minimal clinically important difference in pain levels. They concluded that widespread pain as captured by the pain diagram, along with the pain catastrophizing score, may help identify persons with suboptimal TKA outcome.…”

Prevalence of Persistent Pain after Total Knee Arthroplasty and the Impact of Neuropathic Pain

“…34 Preoperative widespread pain was associated with more pain after TKA and failure to achieve relief from pain as defined by a minimal clinically significant difference after 12 months. 35 Surgeons should understand their patients and determine an indication for TKA to prevent persistent severe postsurgical pain.…”

Cost‐Effectiveness of Diet and Exercise for Overweight and Obese Patients With Knee Osteoarthritis

“…TKA structural efficacy rates were derived from data in a study by Paxton and colleagues . TKA pain decrements were derived from 2 longitudinal studies in patients with knee OA undergoing TKA: the Adding Value in Knee Arthroplasty (AViKA) study and the Study of Total Knee Arthroplasty Responses (STARs) (see Supplementary Appendix Section a and Supplementary Table , available on the Arthritis Care & Research web site at http://onlinelibrary.wiley.com/doi/10.1002/acr23716/abstract).…”