Nikolai Kornilov1, Maren Falch Lindberg2,3, Caryl Gay4,5, Alexander Saraev6, Taras Kuliaba7, Leiv Arne Rosseland8,9, Anners Lerdal3,5. 1. Department of Knee Surgery N 17, Russian Research Institute of Traumatology and Orthopaedics n.a. R.R. Vreden, Saint-Petersburg, Russia, 195427. drkornilov@hotmail.com. 2. Department of Surgery, Lovisenberg Diakonale Hospital, 0440, Oslo, Norway. 3. Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0318, Oslo, Norway. 4. Department of Family Health Care Nursing, University of California, San Francisco, CA, 94143-0606, USA. 5. Department of Research and Development, Lovisenberg Diakonale Hospital, 0440, Oslo, Norway. 6. Department of Knee Surgery N 17, Russian Research Institute of Traumatology and Orthopaedics n.a. R.R. Vreden, Saint-Petersburg, Russia, 195427. 7. Department of Knee Surgery N 10, Russian Research Institute of Traumatology and Orthopaedics n.a. R.R. Vreden, Saint-Petersburg, Russia, 195427. 8. Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, 0424, Oslo, Norway. 9. Institute of Clinical Medicine, University of Oslo, 0316, Oslo, Norway.
Abstract
PURPOSE: The purpose of this study was to describe patterns of pain during the first year following total knee arthroplasty (TKA) and evaluate pre- and postoperative factors associated with pain and patient satisfaction at 1 year. It was hypothesized that more severe preoperative pain would be associated with more residual pain and lower patient satisfaction 1 year after surgery. METHODS: A longitudinal cohort study was performed with repeated measures of pain (0-10 numeric rating scale) and evaluation of other self-reported symptoms (Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and Fatigue Severity Score), daily functioning (Lawton Instrumental Activities of Daily Living Scale), quality of life (EQ-5D-3L), knee function (KSS Knee and Function Score), perioperative and clinical characteristics (e.g. surgery duration, brand of implant, comorbidities), biochemical parameters (haemoglobin, C-reactive protein, creatinine), and patient satisfaction (20-item scale). Post-surgical improvement was defined as at least a two-point decrease in the patient's rating of pain interference with walking from baseline to 1 year. Hundred patients (mean age 64 ± 8 years and 93% female) consecutively admitted for uncomplicated primary TKA participated, and 79 with complete data were included in this analysis. RESULTS: Pain generally decreased during the first postoperative year, from an average rating of 6 (SD = 3) to 1 (SD = 2). However, 18 of the 79 patients experienced no improvement in pain from baseline to 1 year. Factors associated with non-improvement of pain interference with walking after TKA included lower preoperative ratings of pain interference with walking (p < 0.001) and lower preoperative ratings of average pain (p = 0.004), active or very active levels of preoperative physical activity (p = 0.017), and higher ratings of worst pain on the first three postoperative days (p = 0.028). Pain at 1 year was the only predictor of lower patient satisfaction at 1 year. CONCLUSIONS: Patients with low preoperative pain ratings or high preoperative levels of physical activity are at increased risk of non-improvement in knee pain after TKA. This finding should be taken into consideration when selecting appropriate candidates for TKA surgery. Orthopaedic surgeons should pay particular attention to patients reporting low pain interference with walking and consider other conservative or surgical treatment options before TKA. Effective strategies for detection and treatment of TKA patients with high pain ratings at early follow-up visits also need to be developed. LEVEL OF EVIDENCE: Prognostic study, Level II.
PURPOSE: The purpose of this study was to describe patterns of pain during the first year following total knee arthroplasty (TKA) and evaluate pre- and postoperative factors associated with pain and patient satisfaction at 1 year. It was hypothesized that more severe preoperative pain would be associated with more residual pain and lower patient satisfaction 1 year after surgery. METHODS: A longitudinal cohort study was performed with repeated measures of pain (0-10 numeric rating scale) and evaluation of other self-reported symptoms (Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and Fatigue Severity Score), daily functioning (Lawton Instrumental Activities of Daily Living Scale), quality of life (EQ-5D-3L), knee function (KSS Knee and Function Score), perioperative and clinical characteristics (e.g. surgery duration, brand of implant, comorbidities), biochemical parameters (haemoglobin, C-reactive protein, creatinine), and patient satisfaction (20-item scale). Post-surgical improvement was defined as at least a two-point decrease in the patient's rating of pain interference with walking from baseline to 1 year. Hundred patients (mean age 64 ± 8 years and 93% female) consecutively admitted for uncomplicated primary TKA participated, and 79 with complete data were included in this analysis. RESULTS:Pain generally decreased during the first postoperative year, from an average rating of 6 (SD = 3) to 1 (SD = 2). However, 18 of the 79 patients experienced no improvement in pain from baseline to 1 year. Factors associated with non-improvement of pain interference with walking after TKA included lower preoperative ratings of pain interference with walking (p < 0.001) and lower preoperative ratings of average pain (p = 0.004), active or very active levels of preoperative physical activity (p = 0.017), and higher ratings of worst pain on the first three postoperative days (p = 0.028). Pain at 1 year was the only predictor of lower patient satisfaction at 1 year. CONCLUSIONS:Patients with low preoperative pain ratings or high preoperative levels of physical activity are at increased risk of non-improvement in knee pain after TKA. This finding should be taken into consideration when selecting appropriate candidates for TKA surgery. Orthopaedic surgeons should pay particular attention to patients reporting low pain interference with walking and consider other conservative or surgical treatment options before TKA. Effective strategies for detection and treatment of TKA patients with high pain ratings at early follow-up visits also need to be developed. LEVEL OF EVIDENCE: Prognostic study, Level II.
Entities:
Keywords:
Outcome; Pain; Patient satisfaction; Total knee arthroplasty
Authors: H Breivik; P C Borchgrevink; S M Allen; L A Rosseland; L Romundstad; E K Breivik Hals; G Kvarstein; A Stubhaug Journal: Br J Anaesth Date: 2008-05-16 Impact factor: 9.166
Authors: Vikki Wylde; Adrian Sayers; Erik Lenguerrand; Rachael Gooberman-Hill; Mark Pyke; Andrew D Beswick; Paul Dieppe; Ashley W Blom Journal: Pain Date: 2015-01 Impact factor: 7.926
Authors: Lise Husby Høvik; Siri Bjørgen Winther; Olav A Foss; Kari Hanne Gjeilo Journal: BMC Musculoskelet Disord Date: 2016-05-17 Impact factor: 2.362
Authors: Pedro Jesús Ruiz-Montero; Gerardo José Ruiz-Rico Ruiz; Ricardo Martín-Moya; Pedro José González-Matarín Journal: Int J Environ Res Public Health Date: 2019-09-04 Impact factor: 3.390
Authors: Julia Felix; Christian Becker; Matthias Vogl; Peter Buschner; Werner Plötz; Reiner Leidl Journal: Health Qual Life Outcomes Date: 2019-12-09 Impact factor: 3.186