J Knee Surg 2023; 36(07): 785-791
DOI: 10.1055/s-0042-1743228
Original Article

Comparison of Acute-Phase Pain Intensity, Pain Trajectory, and the Number of Analgesics Administered between Total and Unicompartmental Knee Arthroplasties

1   Department of Rehabilitation, Anshin Hospital, Kobe, Japan
2   Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
,
Ryota Imai
3   School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Osaka, Japan
,
Osamu Wada
1   Department of Rehabilitation, Anshin Hospital, Kobe, Japan
,
Kiyonori Mizuno
4   Department of Orthopedics, Anshin Hospital, Kobe, Japan
› Author Affiliations
Funding None.

Abstract

We aimed to compare the variables of pain intensity, pain trajectory, and the number of analgesics administered during the acute phase between total and unicompartmental knee arthroplasties. This prospective cohort study recruited 445 patients who planned to undergo knee arthroplasty. Pain intensity was evaluated during hospitalization, and 1 month postoperatively using a numerical rating scale. Pain trajectory (slope and intercept) was calculated using pain intensity data from postoperative days 1 to 4. The number of analgesics administered for worsening pain was monitored during hospitalization. Multiple linear regression analysis with adjustment for potential confounders was conducted to investigate the impact of surgery type on pain variables. Data for 208 and 189 patients who had undergone total and unicompartmental knee arthroplasties, respectively, were included in this study. Pain intensity and pain trajectory were similar between the two surgeries. The number of analgesics administered on postoperative day 3 (p = 0.01) and day 4 (p = 0.03), as well as total number (p = 0.01), were lower for unicompartmental knee arthroplasty than for total knee arthroplasty. Multiple linear regression analysis showed that the type of surgery affected the total number of analgesics administered (β = − 1.24, p < 0.01, 95% confidence interval: −1.80 to −0.62). This study suggests that pain characteristics observed during the acute phase differ between total and unicompartmental knee arthroplasties. Postoperative pain should be managed, and rehabilitation should be provided at similar levels after the second postoperative day in total and unicompartmental knee arthroplasty patients.

Availability of Data and Material

The datasets generated during and/or analyzed during the present study are available from the corresponding author on reasonable request.


Consent to Participate

Obtaining patients' informed consent for the present study was not mandatory according to the “Ethical Guidelines for Medical and Health Research Involving Human subjects” in Japan. However, all patients provided written informed consent prior to participation.


Authors' Contributions

T.O. and W.O. helped in research idea and study design; TO and KM acquired data; T.O., R.I., W.O., and KM were involved in data analysis and interpretation; T.O. was involved in statistical analysis; R.I., O.W., and K.M. were involved in supervision or mentorship. Each author contributed important intellectual content during article drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.


Ethical Approval

The ethics committee approved all procedures performed in this study prior to study commencement (approval protocol number: no. 98; date of approval: December 20, 2019).




Publication History

Received: 03 May 2021

Accepted: 09 January 2022

Article published online:
18 February 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Kennedy DM, Stratford PW, Riddle DL, Hanna SE, Gollish JD. Assessing recovery and establishing prognosis following total knee arthroplasty. Phys Ther 2008; 88 (01) 22-32
  • 2 Johal S, Nakano N, Baxter M, Hujazi I, Pandit H, Khanduja V. Unicompartmental knee arthroplasty: the past, current controversies, and future perspectives. J Knee Surg 2018; 31 (10) 992-998
  • 3 Andersen LØ, Gaarn-Larsen L, Kristensen BB, Husted H, Otte KS, Kehlet H. Subacute pain and function after fast-track hip and knee arthroplasty. Anaesthesia 2009; 64 (05) 508-513
  • 4 Buvanendran A, Della Valle CJ, Kroin JS. et al. Acute postoperative pain is an independent predictor of chronic postsurgical pain following total knee arthroplasty at 6 months: a prospective cohort study. Reg Anesth Pain Med 2019; 44 (03) e100036
  • 5 Thiam WD, Teh JW, Bin Abd Razak HR, Tan HC. Correlations between functional knee outcomes and health-related quality of life after total knee arthroplasty in an Asian Population. J Arthroplasty 2016; 31 (05) 989-993
  • 6 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
  • 7 Wilson HA, Middleton R, Abram SGF. et al. Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ 2019; 364: l352
  • 8 Dalury DF, Fisher DA, Adams MJ, Gonzales RA. Unicompartmental knee arthroplasty compares favorably to total knee arthroplasty in the same patient. Orthopedics 2009;32(04):
  • 9 Newman JH, Ackroyd CE, Shah NA. Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis. J Bone Joint Surg Br 1998; 80 (05) 862-865
  • 10 Sun PF, Jia YH. Mobile bearing UKA compared to fixed bearing TKA: a randomized prospective study. Knee 2012; 19 (02) 103-106
  • 11 Guichard L, Vanhaesebrouck A, Fletcher D, Stiglitz Y, Rouquette A, Martinez V. Pain trajectory after ankle surgeries for osteoarthritis. Foot Ankle Int 2019; 40 (04) 367-373
  • 12 Okamoto A, Yamasaki M, Yokota I. et al. Classification of acute pain trajectory after breast cancer surgery identifies patients at risk for persistent pain: a prospective observational study. J Pain Res 2018; 11: 2197-2206
  • 13 Ocay DD, Li MMJ, Ingelmo P, Ouellet JA, Pagé MG, Ferland CE. Predicting acute postoperative pain trajectories and long-term outcomes of adolescents after spinal fusion surgery. Pain Res Manag 2020; 2020: 9874739
  • 14 Chapman CR, Donaldson GW, Davis JJ, Bradshaw DH. Improving individual measurement of postoperative pain: the pain trajectory. J Pain 2011; 12 (02) 257-262
  • 15 Leiss F, Götz JS, Maderbacher G. et al. Pain management of unicompartmental (UKA) vs. total knee arthroplasty (TKA) based on a matched pair analysis of 4144 cases. Sci Rep 2020; 10 (01) 17660
  • 16 Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs 2005; 14 (07) 798-804
  • 17 Imai R, Osumi M, Ishigaki T, Nishigami T, Yonemoto Y, Morioka S. Development of more precise measurement to predict pain 1 month postoperatively based on use of acute postoperative pain score in patients with distal radial fracture. Pain Pract 2020; 20 (07) 752-760
  • 18 Mahure SA, Feng JE, Schwarzkopf RM, Long WJ. Differences in pain, opioid use, and function following unicompartmental knee arthroplasty compared to total knee arthroplasty. J Arthroplasty 2020; 35 (09) 2435-2438
  • 19 Jiang J, Teng Y, Fan Z, Khan MS, Cui Z, Xia Y. The efficacy of periarticular multimodal drug injection for postoperative pain management in total knee or hip arthroplasty. J Arthroplasty 2013; 28 (10) 1882-1887
  • 20 Hernández C, Díaz-Heredia J, Berraquero ML, Crespo P, Loza E, Ruiz Ibán MÁ. Pre-operative predictive factors of post-operative pain in patients with hip or knee arthroplasty: a systematic review. Reumatol Clin 2015; 11 (06) 361-380
  • 21 Townsend LA, Roubion RC, Bourgeois DM. et al. Impact of age on patient-reported outcome measures in total knee arthroplasty. J Knee Surg 2018; 31 (06) 580-584
  • 22 Høvik LH, Winther SB, Foss OA, Gjeilo KH. Preoperative pain catastrophizing and postoperative pain after total knee arthroplasty: a prospective cohort study with one year follow-up. BMC Musculoskelet Disord 2016; 17: 214
  • 23 Sorel JC, Veltman ES, Honig A, Poolman RW. The influence of preoperative psychological distress on pain and function after total knee arthroplasty: a systematic review and meta-analysis. Bone Joint J 2019; 101-B (01) 7-14