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

Masahiro Hasegawa; Shine Tone; Yohei Naito; Hiroki Wakabayashi; Akihiro Sudo

doi:10.1055/s-0038-1675415

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2019; 32(10): 1020-1023
DOI: 10.1055/s-0038-1675415

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Masahiro Hasegawa

¹Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Mie, Japan

,

Shine Tone

¹Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Mie, Japan

,

Yohei Naito

¹Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Mie, Japan

,

Hiroki Wakabayashi

¹Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Mie, Japan

,

Akihiro Sudo

¹Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Mie, Japan

› Author Affiliations

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

Full Text

References

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 (09) 1227-1233
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