Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2015; 6(7): 528-536
Published online Aug 18, 2015. doi: 10.5312/wjo.v6.i7.528
Persistent post-surgical pain and neuropathic pain after total knee replacement
Georgios I Drosos, Triantafilia Triantafilidou, Athanasios Ververidis, Cristina Agelopoulou, Theodosia Vogiatzaki, Konstantinos Kazakos
Georgios I Drosos, Triantafilia Triantafilidou, Athanasios Ververidis, Konstantinos Kazakos, Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
Cristina Agelopoulou, Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
Theodosia Vogiatzaki, Department of Anaesthesia, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
Author contributions: Drosos GI, Triantafilidou T and Agelopoulou C contributed to conception and design of the study; Drosos GI, Triantafilidou T and Ververidis A contributed to acquisition; analysis and interpretation of data; Drosos GI, Triantafilidou T and Agelopoulou C contributed to drafting the article; Ververidis A, Vogiatzaki T and Kazakos K contributed to revising the article; all the authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that there is no conflict of interest for this work. They have received no funds from any commercial party in relation to this work.
Data sharing statement: It does not apply in this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Georgios I Drosos, MD, PhD, Assistant Professor, Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100 Alexandroupolis, Greece. drosos@otenet.gr
Telephone: +30-6944-380694 Fax: +30-25513-30339
Received: March 5, 2015
Peer-review started: March 8, 2015
First decision: April 10, 2015
Revised: May 16, 2015
Accepted: June 1, 2015
Article in press: June 2, 2015
Published online: August 18, 2015
Abstract

AIM: To study the prevalence of persistent post-surgical pain (PPSP) and neuropathic pain (NP) after total knee replacement (TKR).

METHODS: MEDLINE and Embase databases were searched for articles published until December 2014 in English language. Published articles were included if they referred to pain that lasts at least 3 mo after primary TKR for knee osteoarthritis, and measured pain with pain specific instruments. Studies that referred to pain caused by septic reasons and implant malalignment were excluded. Both prospective and retrospective studies were included and only 14 studies that match the inclusion criteria were selected for this review.

RESULTS: The included studies were characterized by the heterogeneity on the scales used to measure pain and pre-operative factors related to PPSP and NP. The reported prevalence of PPSP and NP seems to be relatively high, but it varies among different studies. There is also evidence that the prevalence of post-surgical pain is related to the scale used for pain measurement. The prevalence of PPSP is ranging at 6 mo from 16% to 39% and at 12 mo from 13.1% to 23% and even 38% of the patients. The prevalence of NP at 6 mo post-operatively is ranging from 5.2% to 13%. Pre-operative factors related to the development of PPSP also differ, including emotional functioning, such as depression and pain catastrophizing, number of comorbidities, pain problems elsewhere and operations in knees with early grade of osteoarthritis.

CONCLUSION: No firm conclusions can be reached regarding the prevalence of PPSP and NP and the related factors due to the heterogeneity of the studies.

Keywords: Total knee replacement, Pain, Chronic pain, Neuropathic pain, Post-operative pain, Persistent post-surgical pain

Core tip: Persistent post-surgical pain (PPSP) is reported in a significant proportion of patients after total knee replacement. This proportion varies between the different studies and different factors have been implicated including the instrument used to measure pain. It is also obvious that in some of these patients the pain is neuropathic (NP) in origin or the NP pain coexists. Nevertheless, due to the heterogeneity of the studies, mainly on the scales used to assess pain and preoperative factors, we are unable to reach firm conclusions concerning the prevalence, and the risk factors of PPSP pain after total knee replacement. Additional studies focused on the prevalence and risk factors related to PPSP are needed.