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

Abstract

The present study aimed to define the prevalence of pain persisting after total knee arthroplasty (TKA) and determine the impact of neuropathic pain. Knee pain after TKA was evaluated in 154 patients (222 knees with osteoarthritis) using a numerical rating scale (NRS) and followed up for a mean of 4.7 years. The patients were classified according to whether they had no or mild pain (NRS ≤ 3), or moderate-to-severe pain (NRS > 3), and then assigned to groups with nociceptive, unclear, or neuropathic pain based on responses to painDETECT questionnaires. Risk factors for these types of pain were determined. The ratio of patients with moderate-to-severe pain was 28% (62 knees). Thirteen patients (21 knees; 9%) experienced unclear pain. Patients with moderate-to-severe or unclear pain had malalignment and lower Knee Society knee scores. In conclusion, a significant number of patients experienced moderate-to-severe and unclear pain after TKA. Moderate-to-severe pain was associated with unclear pain.

Keywords

total knee arthroplasty - neuropathic pain - patient satisfaction - alignment

• References

• 1 Wylde V, Hewlett S, Learmonth ID, Dieppe P. Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain 2011; 152 (03) 566-572
• 2 Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2012; 2 (01) e000435
• 3 Pinto PR, McIntyre T, Ferrero R, Almeida A, Araújo-Soares V. Risk factors for moderate and severe persistent pain in patients undergoing total knee and hip arthroplasty: a prospective predictive study. PLoS One 2013; 8 (09) e73917
• 4 Wylde V, Bruce J, Beswick A, Elvers K, Gooberman-Hill R. Assessment of chronic postsurgical pain after knee replacement: a systematic review. Arthritis Care Res (Hoboken) 2013; 65 (11) 1795-1803
• 5 Albayrak I, Apiliogullari S, Erkocak OF, Kavalci H, Ozerbil OM, Levendoglu F. Total knee arthroplasty due to knee osteoarthritis: risk factors for persistent postsurgical pain. J Natl Med Assoc 2016; 108 (04) 236-243
• 6 Lim HA, Song EK, Seon JK, Park KS, Shin YJ, Yang HY. Causes of aseptic persistent pain after total knee arthroplasty. Clin Orthop Surg 2017; 9 (01) 50-56
• 7 Hofmann S, Seitlinger G, Djahani O, Pietsch M. The painful knee after TKA: a diagnostic algorithm for failure analysis. Knee Surg Sports Traumatol Arthrosc 2011; 19 (09) 1442-1452
• 8 Scott CE, Howie CR, MacDonald D, Biant LC. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 2010; 92 (09) 1253-1258
• 9 Jensen TS, Baron R, Haanpää M. , et al. A new definition of neuropathic pain. Pain 2011; 152 (10) 2204-2205
• 10 Healy WL, Della Valle CJ, Iorio R. , et al. Complications of total knee arthroplasty: standardized list and definitions of the Knee Society. Clin Orthop Relat Res 2013; 471 (01) 215-220
• 11 Dihle A, Helseth S, Paul SM, Miaskowski C. The exploration of the establishment of cutpoints to categorize the severity of acute postoperative pain. Clin J Pain 2006; 22 (07) 617-624
• 12 Freynhagen R, Baron R, Gockel U, Tölle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 2006; 22 (10) 1911-1920
• 13 Matsubayashi Y, Takeshita K, Sumitani M. , et al. Validity and reliability of the Japanese version of the painDETECT questionnaire: a multicenter observational study. PLoS One 2013; 8 (09) e68013
• 14 Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN. The new Knee Society Knee Scoring System. Clin Orthop Relat Res 2012; 470 (01) 3-19
• 15 Buvanendran A, Kroin JS, Della Valle CJ, Kari M, Moric M, Tuman KJ. Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial. Anesth Analg 2010; 110 (01) 199-207
• 16 Lavand'homme PM, Grosu I, France MN, Thienpont E. Pain trajectories identify patients at risk of persistent pain after knee arthroplasty: an observational study. Clin Orthop Relat Res 2014; 472 (05) 1409-1415
• 17 Phillips JR, Hopwood B, Arthur C, Stroud R, Toms AD. The natural history of pain and neuropathic pain after knee replacement: a prospective cohort study of the point prevalence of pain and neuropathic pain to a minimum three-year follow-up. Bone Joint J 2014; 96-B [phone]
• 18 Kerstman E, Ahn S, Battu S, Tariq S, Grabois M. Neuropathic pain. Handb Clin Neurol 2013; 110 (10) 175-187
• 19 YaDeau JT, Lin Y, Mayman DJ. , et al. Pregabalin and pain after total knee arthroplasty: a double-blind, randomized, placebo-controlled, multidose trial. Br J Anaesth 2015; 115 (02) 285-293
• 20 Martinez V, Pichard X, Fletcher D. Perioperative pregabalin administration does not prevent chronic postoperative pain: systematic review with a meta-analysis of randomized trials. Pain 2017; 158 (05) 775-783
• 21 Choong PF, Dowsey MM, Stoney JD. Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty 2009; 24 (04) 560-569
• 22 Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty 2009; 24 (04) 570-578
• 23 Matziolis G, Adam J, Perka C. Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement. Arch Orthop Trauma Surg 2010; 130 (12) 1487-1491
• 24 Matsuda S, Kawahara S, Okazaki K, Tashiro Y, Iwamoto Y. Postoperative alignment and ROM affect patient satisfaction after TKA. Clin Orthop Relat Res 2013; 471 (01) 127-133
• 25 Blakeney WG, Khan RJ, Palmer JL. Functional outcomes following total knee arthroplasty: a randomised trial comparing computer-assisted surgery with conventional techniques. Knee 2014; 21 (02) 364-368
• 26 Anderl W, Pauzenberger L, Kölblinger R. , et al. Patient-specific instrumentation improved mechanical alignment, while early clinical outcome was comparable to conventional instrumentation in TKA. Knee Surg Sports Traumatol Arthrosc 2016; 24 (01) 102-111
• 27 Huijbregts HJ, Khan RJ, Fick DP, Jarrett OM, Haebich S. Prosthetic alignment after total knee replacement is not associated with dissatisfaction or change in Oxford Knee Score: a multivariable regression analysis. Knee 2016; 23 (03) 535-539
• 28 Mugnai R, Zambianchi F, Digennaro V. , et al. Clinical outcome is not affected by total knee arthroplasty alignment. Knee Surg Sports Traumatol Arthrosc 2016; 24 (10) 3339-3345
• 29 Drexler M, Dwyer T, Chakravertty R, Farno A, Backstein D. Assuring the happy total knee replacement patient. Bone Joint J 2013; 95-B (11, suppl A): 120-123
• 30 Hasegawa M, Miyazaki S, Yamaguchi T, Wakabayashi H, Sudo A. Comparison of midterm outcomes of minimally invasive computer-assisted vs minimally invasive jig-based total knee arthroplasty. J Arthroplasty 2017; 32 (01) 43-46
• 31 Hasegawa M, Naito Y, Yamaguchi T, Wakabayashi H, Sudo A. Factors contributing to patient satisfaction and expectations following computer-assisted total knee arthroplasty. J Knee Surg 2018; 31 (05) 448-452
• 32 Arendt-Nielsen L, Nie H, Laursen MB. , et al. Sensitization in patients with painful knee osteoarthritis. Pain 2010; 149 (03) 573-581
• 33 Fingleton C, Smart K, Moloney N, Fullen BM, Doody C. Pain sensitization in people with knee osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2015; 23 (07) 1043-1056
• 34 Wylde V, Sayers A, Odutola A, Gooberman-Hill R, Dieppe P, Blom AW. Central sensitization as a determinant of patients' benefit from total hip and knee replacement. Eur J Pain 2017; 21 (02) 357-365
• 35 Dave AJ, Selzer F, Losina E. , et al. The association of preoperative body pain diagram scores with pain outcomes following total knee arthroplasty. Osteoarthritis Cartilage 2017; 25 (05) 667-675