Typical Pain Patterns in Unhappy Patients After Total Knee Arthroplasty

Mathis, Dominic T.; Hauser, Antonia; Iordache, Edna; Amsler, Felix; Hirschmann, Michael T.

doi:10.1016/j.arth.2021.01.040

Cited by 9 publications

(18 citation statements)

References 21 publications

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“…A consecutive number of 83 patients, who underwent primary TKA from 1993 to 2017 and complained about unilateral persistent knee pain and who underwent a revision surgery after completing the diagnostic algorithm including SPECT/CT were prospectively collected and then included in this retrospective cohort study. The cohort is mostly consistent (83 of initially 97 patients) with that in the previously published study on TKA pain patterns [ 25 ]. Data were prospectively collected from a specialized knee centre in which the patients presented between 2012 and 2017 due to persistent pain after primary TKA.…”

Section: Methodssupporting

confidence: 78%

“…WB, weight bearing; SPECT/CT, single photon emission computed tomography/computer tomography. Reprinted with permission [ 25 ] …”

Section: Methodsmentioning

confidence: 99%

“…Magnifier shows correlations between pain characters and dynamics. Reprinted with permission [25] injection (Malinckrodt, Wollerau, Switzerland). SPECT/CT was performed using a hybrid system (Symbia T16, Siemens, Erlangen, Germany), which consists of a pair of lowenergy, high-resolution collimators and a dual-head gamma camera with an integrated 16-slice CT scanner (collimation of 16 × 0.75 mm).…”

Section: Radiological Imagingmentioning

confidence: 99%

“…In 2020, this study group was able for the first time to identify pain characteristics in unhappy patients after TKA and link these to specific underlying pathologies. Based on this, pain patterns were found [ 25 ] (Fig. 1 ).…”

Section: Introductionmentioning

confidence: 99%

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Correlations of typical pain patterns with SPECT/CT findings in unhappy patients after total knee arthroplasty

Mathis

Tschudi

Amsler

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose The diagnostic process in patients after painful total knee arthroplasty (TKA) is challenging. The more clinical and radiological information about a patient with pain after TKA is included in the assessment, the more reliable and sustainable the advice regarding TKA revision can be. The primary aim was to investigate the position of TKA components and evaluate bone tracer uptake (BTU) using pre-revision SPECT/CT and correlate these findings with previously published pain patterns in painful patients after TKA. Methods A prospectively collected cohort of 83 painful primary TKA patients was retrospectively evaluated. All patients followed a standardized diagnostic algorithm including 99m-Tc-HDP-SPECT/CT, which led to a diagnosis indicating revision surgery. Pain character, location, dynamics and radiation were systematically assessed as well as TKA component position in 3D-CT. BTU was anatomically localized and quantified using a validated localization scheme. Component positioning and BTU were correlated with pain characteristics using non-parametric Spearman correlations (p < 0.05). Results Based on Spearman’s rho, significant correlations were found between pain and patients characteristics and SPECT/CT findings resulting in nine specific patterns. The most outstanding ones include: Pattern 1: More flexion in the femoral component correlated with tender/splitting pain and patella-related pathologies. Pattern 3: More varus in the femoral component correlated with dull/heavy and tingling/stinging pain during descending stairs, unloading and long sitting in patients with high BMI and unresurfaced patella. Pattern 6: More posterior slope in the tibial component correlated with constant pain. Conclusion The results of this study help to place component positioning in the overall context of the "painful knee arthroplasty" including specific pain patterns. The findings further differentiate the clinical picture of a painful TKA. Knowing these patterns enables a prediction of the cause of the pain to be made as early as possible in the diagnostic process before the state of pain becomes chronic. Level of evidence Level III

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Section: Methodssupporting

confidence: 78%

“…WB, weight bearing; SPECT/CT, single photon emission computed tomography/computer tomography. Reprinted with permission [ 25 ] …”

Section: Methodsmentioning

confidence: 99%

Section: Radiological Imagingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Correlations of typical pain patterns with SPECT/CT findings in unhappy patients after total knee arthroplasty

Mathis

Tschudi

Amsler

et al. 2021

Knee Surg Sports Traumatol Arthrosc

Self Cite

View full text Add to dashboard Cite

show abstract

“…As reported by Mathis regarding total knee arthroplasty (TKA), if the causes of the post-UKA complaints are known, a decision for therapy can be made reliably and sustainably at an early stage before the pain becomes chronic [26]. According to this statement, PEMFs therapy may represent an important adjunct to post-operative to avoid chronic pain onset by preventing the detrimental effect of inflammation induced by UKA on joint tissues, thereby resulting in short and long-term benefits for patients.…”

Section: Discussionmentioning

confidence: 99%

Pulsed electromagnetic fields improve pain management and clinical outcomes after medial unicompartmental knee arthroplasty: A prospective randomised controlled trial

et al. 2022

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Less pain reported 5 years after cementless compared to cemented unicompartmental knee replacement: an analysis of pain, neuropathy, and co‐morbidity scores

Rahman,

Martin,

Jenkins

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To compare patient-reported pain scores and assess the influence of neuropathy and co-morbidity, on knee pain following cemented and cementless medial unicompartmental knee replacement (UKR) 5 years after surgery. Method In this longitudinal study, 262 cemented and 262 cementless Oxford UKR performed for the same indications and with the same techniques were recruited. Patients were reviewed at five years, evaluating patient-reported pain and association with clinical outcomes. Intermittent and Constant Osteoarthritis Pain (ICOAP), PainDETECT (PD), Charnley score, Oxford Knee Score (OKS) and American Knee Society Score (AKSS) were compared. Results In both cohorts, intermittent pain was more common than constant pain (47% vs 21%). Cementless knees reported significantly less pain than cemented (ICOAP-Total 5/100 vs 11/100, p < 0.0001). A greater proportion of cementless knees experienced no pain at all (ICOAP = 0/100, 61% vs 43%, p < 0.0001) and 75% fewer experienced severe or extreme pain. Pain sub-scores in PD, OKS and AKSS follow this trend. Pain was unlikely to be neuropathic (PD positive: 5.26%), but patients reporting high levels of ‘strongest’ pain were three times more likely to be neuropathic. Patients with co-morbidities (Charnley C) experienced greater pain than those without (Charnley A+B) across all knee-specific scores, despite scores being knee specific. Conclusion Both cemented and cementless UKR in this study had substantially less pain than that reported in literature following TKR. Cementless UKR had significantly less pain than cemented UKR in all scores. Two-thirds of patients with a cementless UKR had no pain at all at 5 years, and pain experienced was most likely to be mild and intermittent with no patients in severe or extreme pain. Patients with cementless UKR that had higher levels of pain were more likely to have co-morbidity or evidence or neuropathic pain. It is unclear why cementless UKR have less pain than cemented; further study is necessary.

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Typical Pain Patterns in Unhappy Patients After Total Knee Arthroplasty

Cited by 9 publications

References 21 publications

Correlations of typical pain patterns with SPECT/CT findings in unhappy patients after total knee arthroplasty

Correlations of typical pain patterns with SPECT/CT findings in unhappy patients after total knee arthroplasty

Pulsed electromagnetic fields improve pain management and clinical outcomes after medial unicompartmental knee arthroplasty: A prospective randomised controlled trial

Less pain reported 5 years after cementless compared to cemented unicompartmental knee replacement: an analysis of pain, neuropathy, and co‐morbidity scores

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