Systematic Reviews
Copyright ©The Author(s) 2015.
World J Orthop. Aug 18, 2015; 6(7): 528-536
Published online Aug 18, 2015. doi: 10.5312/wjo.v6.i7.528
Table 1 Total knee replacement and chronic (persistent) post-surgical pain
Ref.Design/patientsAim of the studyScores-scalesFollow-upPainFactors
Brander et al[19]Prospective n = 116To describe the natural history of pain after TKR To identify factors predicting excessive post-surgical painVAS and other measures of patient healthPre-op. Post-op.: (1) 1 mo; (2) 3 mo; (3) 6 mo; and (4) 12 moPre-op.: 72.3% Post op.: (1) 44.4%; (2) 22.6%; (3) 18.4%; and (4) 13.1%, respectivelyFactors related with post-op pain at 12 mo (1) Pre-operative pain; and (2) Pre-operative depression and anxiety
Forsythe et al[20]Prospective n = 55To document: the prospective pain experience following TKR To determine if: (1) comorbidities; (2) preoperative pain; or (3) preoperative pain catastrophizing scores are predictors of chronic pain after TKRMPQ PCSPre-op. Post-op.: (1) 3 mo; (2) 12 mo; and (3) 24 moSignificant reduction only between pre-op and 3-mo post-op values. After 3-mo pain had reached a plateau Pain catastrophizing scores didn’t show any significant differencesPredictive of chronic postoperative pain: (1) No. of comorbidities; and (2) Pre-operative pain catastrophizing scores
Ritter et al[24]Retrospective n = 7326To quantify the effect of sex on the clinical outcome and survivorship of a specific TKR (AGC, Biomet, Warsaw, Ind)KSS PS FSClinical scores: Throughout 5 yr Survival data: Up to 17 yrPain after TKR was less for men but there was no statistically significant difference between men and womenImprovement after TKR is similar for men and women No significant difference in post-operative pain between men and women
Wylde et al[9]Retrospective n = 632To assess the (1) prevalence; (2) severity; (3) sensory qualities; and (4) postoperative determinants of persistent pain after primary THR and TKRWOMAC Pain Scale SFMPQ pD-Q Two-item Patient Health Questionnaire (PHQ-2)Median: 41 mo Range: 34-49 moPersistent post-surgical pain (PPSP): 44% Severe-extreme PPSP: 15% Constant PPSP: 5% Likely neuropathic pain: 6%Significant and independent postoperative determinants of number of PPSP: (1) No. of pain problems elsewhere; and (2) The presence of major depression
Polkowski et al[23]Prospective n = 309To explore the relationship between early-grade preoperative OA with pain and dissatisfaction after TKRGroup A: Pain after TKR Group B: Consecutive series of 100 TKR’s performed the same period by the same surgeon Group C: Asymptomatic TKR Group D: Symptomatic TKR performed the same period1-5 yrEarly-grade OA pre-op: Group A: 49% Group B: 5% Group C: 6% Group D: 10%.A high percentage of patients referred for unexplained pain after TKR had early-grade OA pre-operatively
Noiseux et al[21]Prospective n = 215Τo discover whether any preoperative assessment could predict high pain scores and functional limitations postoperativelyPain Intensity rating: NRS QST Anxiety Form of the State Trait Anxiety Inventory GDS PCSPre-op. Post-op.: 6 moModerate to severe pain At rest: Pre-op.: 17% Post-op.: 5% With range-of-motion: Pre-op.: 52% Post-op.: 16%Significant predictors (for moderate or severe TKR pain with knee motion after 6 mo): (1) Severe preoperative knee pain with range-of motion; and (2) Anxiety
Pérez-Prieto et al[22]Prospective n = 716 Depressed: n = 200To evaluate quality of life, function, pain and satisfaction outcomes in patients, with and without depression, undergoing TKRGDS KSS Medical Outcomes Study 36-Item Short Form Health (SF-36) MCS VAS12 moDepressed patients reported significant higher pain scores than non-depressed patients pre- and post-operatively Net changes (postoperative - preoperative): No significant differenceDepression leads to (1) Poorer preoperative and postoperative scores in all but the mental domains; and (2) But similar net score changes (improvement) with a high rate of patient satisfaction
W-Dahl et al[25]Non-depressed: n = 516 retrospectiveTo evaluate how the instruments used to measure pain affected the number of patients who reported no relief of pain or worse pain, and the relative effect of potential risk factorsOsteoarthritis Outcome Score (KOOS) VAS EQ-5DPre-operatively 1 year post-operativelyNo pain relief: 10.1% Only KOOS pain: 25% Only VAS knee pain: 52% Both: 23%The observed proportion of patients with unchanged or worse pain one year after TKR differed depending on the method of pain measurement used Risk factors for no pain relief are: (1) less pre-operative pain; and (2) higher degree of anxiety Charnley category C was a risk factor for unchanged or worse pain as measured by the VAS but not for the KOOS