Preoperative Predictors of Pain Following Total Knee Arthroplasty

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Abstract

Total knee arthroplasty has provided dramatic improvements in function and pain for the majority of patients with knee arthritis, yet a significant proportion of patients remain dissatisfied with their results. We performed a prospective analysis of 215 patients undergoing TKA who underwent a comprehensive array of evaluations to discover whether any preoperative assessment could predict high pain scores and functional limitations postoperatively. Patients with severe pain with a simple knee range-of-motion test prior to TKA had a 10 times higher likelihood of moderate to severe pain at 6 months. A simple test of pain intensity with active flexion and extension preoperatively was a significant predictor of postoperative pain at 6 months after surgery. Strategies to address this particular patient group may improve satisfaction rates of TKA.

Section snippets

Patients

This was a prospective cohort study involving patients recruited to a larger randomized controlled trial studying the effectiveness of TENS on pain and function after total knee arthroplasty.

Two hundred fifteen patients underwent a comprehensive multi-faceted evaluation during their TKA preoperative visit. Postoperative assessments were performed at the 6-month clinic visit (n = 193). All patients provided informed consent and the study was approved by the University of Iowa and VA institutional

Results

There were 215 patients in the study. Mean age 61.68 ± 9.82 years. Mean BMI of 38.18 ± 11.43. Most were women (n = 125, 58%), white (n = 200, 98%), had college education (n = 130, 61%), and married (n = 119, 55.3%). The affected knee in most subjects had an OA K/L grade > or = 3 (n = 172, 80%) and had been painful for > 5 years.

The distribution of patient-scored pain intensity ratings in the surgical knee preoperatively and at six months postoperatively is presented in Table 1.

Discussion

Many investigators have documented the improvement in function and long term durability of total knee replacement procedures 1., 2., 3., 4., 5.. Surgeons performing the operation have increasingly been aware that a non-trivial percentage of patients are unhappy following the procedure even though there are no recognized complications such as infection, instability, loosening, malalignment or implant failure 12., 13., 18., 20., 25., 53., 54.. Recent investigations have documented 15–20% rates of

Acknowledgments

We would like to thank the following for contributions to study design, data collection and data analysis: Nicole Petsas-Blodgett, PhD, MSN, RN; Nyla Logsdon-Sackett, MS; Timothy Brennan, PhD; Keela Herr, PhD, RN, FAAN; Katharine Geasland, BS, RN; Xiaoyan Yang, MS.

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    Funding Source: National Institute of Nursing Research (NINR) R01 NR009844.

    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2014.01.034.

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