scholarly journals Demographic and Psychosocial Predictors of Acute Perioperative Pain for Total Knee Arthroplasty

2007 ◽  
Vol 12 (3) ◽  
pp. 185-194 ◽  
Author(s):  
Maya L Roth ◽  
Dean A Tripp ◽  
Mark H Harrison ◽  
Michael Sullivan ◽  
Patricia Carson
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Pain Catastrophizing ◽  
Short Form ◽  
Negative Mood ◽  
Mcgill Pain Questionnaire ◽  
North American Population ◽  
Total Knee ◽  
The Impact

BACKGROUND: As the North American population ages, the prevalence of knee osteoarthritis and the surgical interventions (ie, total knee arthroplasty [TKA]) aimed at correcting pain and disability will also rise proportionally. Therefore, efforts to better understand the factors associated with surgical outcomes are warranted. To date, no studies have examined the impact of psychosocial factors on acute postoperative TKA pain.OBJECTIVES: The primary objective was to examine the associations among catastrophizing, negative mood, demographics and acute postoperative pain following TKA. Ancillary analyses examined the association of preoperative psychological variables with postoperative pain.METHODS: Patients completed questionnaire packages 2 h before their surgery and on three consecutive postoperative days while in the hospital. The questionnaire packages included the Short Form –McGill Pain Questionnaire, the Pain Catastrophizing Scale and the Shortened Version of Profile of Mood States. The Mini-Mental State Examination was also administered. Demographic data were extracted from patients’ medical charts.RESULTS: Associations among catastrophizing, negative mood and pain were established. Regressions showed that younger age predicted greater preoperative and postoperative day 1 pain; catastrophizing predicted preoperative and postoperative day 2 pain; and negative mood predicted postoperative day 3 pain. Catastrophizing and negative mood were highly correlated at several assessment points. Preoperative variables did not predict postoperative pain.CONCLUSION: These results have postoperative pain management implications. Heightened attention to psychosocial variables, such as postoperative catastrophizing and negative mood, may be useful in identifying patients at risk for greater postoperative pain.

scholarly journals Myofascial Pain in Patients Waitlisted for Total Knee Arthroplasty

2012 ◽  
Vol 17 (5) ◽  
pp. 321-327 ◽  
Author(s):  
Richard Henry ◽  
Catherine M Cahill ◽  
Gavin Wood ◽  
Jennifer Hroch ◽  
Rosemary Wilson ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Myofascial Pain ◽  
Trigger Point ◽  
Short Form ◽  
Trigger Points ◽  
Mcgill Pain Questionnaire ◽  
Myofascial Trigger Points ◽  
Total Knee

BACKGROUND: Knee pain is one of the major sources of pain and disability in developed countries, particularly in aging populations, and is the primary indication for total knee arthroplasty (TKA) in patients with osteoarthritis (OA).OBJECTIVES: To determine the presence of myofascial pain in OA patients waitlisted for TKA and to determine whether their knee pain may be alleviated by trigger point injections.METHODS: Following ethics approval, 25 participants were recruited from the wait list for elective unilateral primary TKA at the study centre. After providing informed consent, all participants were examined for the presence of active trigger points in the muscles surrounding the knee and received trigger point injections of bupivacaine. Assessments and trigger point injections were implemented on the first visit and at subsequent visits on weeks 1, 2, 4 and 8. Outcome measures included the Timed Up and Go test, Brief Pain Inventory, Centre for Epidemiologic Studies Depression Scale, State-Trait Anxiety Inventory and Short-Form McGill Pain Questionnaire.RESULTS: Myofascial trigger points were identified in all participants. Trigger point injections significantly reduced pain intensity and pain interference, and improved mobility. All participants had trigger points identified in medial muscles, most commonly in the head of the gastrocnemius muscle. An acute reduction in pain and improved functionality was observed immediately following intervention, and persisted over the eight-week course of the investigation.CONCLUSION: All patients had trigger points in the vastus and gastrocnemius muscles, and 92% of patients experienced significant pain relief with trigger point injections at the first visit, indicating that a significant proportion of the OA knee pain was myofascial in origin. Further investigation is warranted to determine the prevalence of myofascial pain and whether treatment delays or prevents TKA.

scholarly journals The Impact of Demographic, Clinical, Symptom and Psychological Characteristics on the Trajectories of Acute Postoperative Pain After Total Knee Arthroplasty

Pain Medicine ◽  
2016 ◽  
Vol 18 (1) ◽  
pp. 124-139 ◽  
Author(s):  
Maren Falch Lindberg ◽  
Christine Miaskowski ◽  
Tone Rustøen ◽  
Leiv Arne Rosseland ◽  
Steven M. Paul ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Clinical Symptom ◽  
Knee Arthroplasty ◽  
Psychological Characteristics ◽  
Acute Postoperative Pain ◽  
Total Knee ◽  
The Impact

The influence of preoperative psychological distress on pain and function after total knee arthroplasty

2019 ◽  
Vol 101-B (1) ◽  
pp. 7-14 ◽  
Author(s):  
J. C. Sorel ◽  
E. S. Veltman ◽  
A. Honig ◽  
R. W. Poolman
Keyword(s):  
Total Knee Arthroplasty ◽  
Psychological Distress ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Pain Catastrophizing ◽  
Meta Analysis ◽  
Random Effects Models ◽  
Total Knee ◽  
And Function

AimsWe performed a meta-analysis investigating the association between preoperative psychological distress and postoperative pain and function after total knee arthroplasty (TKA).Materials and MethodsPubmed/Medline, Embase, PsycINFO, and the Cochrane library were searched for studies on the influence of preoperative psychological distress on postoperative pain and physical function after TKA. Two blinded reviewers screened for eligibility and assessed the risk of bias and the quality of evidence. We used random effects models to pool data for the meta-analysis.ResultsSix prospective cohort studies, with a total of 1525 patients, were included. The random effects models showed significantly poorer outcomes in patients who preoperatively had elevated scores on the pain catastrophizing scale, worse 36-Item Short-Form Health Survey (SF-36) mental health score, symptoms of anxiety and/or depression, and somatization dysfunction. After 12 months, the standard mean difference for pain was −0.74 (95% confidence interval (CI) −1.04 to −0.44) and −0.56 (95% CI −0.80 to −0.32) for function.ConclusionPreoperative pain catastrophizing, mental distress, symptoms of anxiety and/or depression, and somatoform disorders appear to adversely affect pain and function after TKA. Some patients undergoing TKA may therefore need psychological support to improve the outcome and quality of life.

Comparison of patient-reported outcomes based on implant brand in total knee arthroplasty

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 48-54 ◽  
Author(s):  
C. A. Kahlenberg ◽  
S. Lyman ◽  
A. D. Joseph ◽  
Y-F. Chiu ◽  
D. E. Padgett
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Smoking Status ◽  
Short Form ◽  
Implant Design ◽  
Patient Reported ◽  
Total Knee ◽  
Healthcare Administrators ◽  
The Impact

AimsThe outcomes of total knee arthroplasty (TKA) depend on many factors. The impact of implant design on patient-reported outcomes is unknown. Our goal was to evaluate the patient-reported outcomes and satisfaction after primary TKA in patients with osteoarthritis undergoing primary TKA using five different brands of posterior-stabilized implant.Patients and MethodsUsing our institutional registry, we identified 4135 patients who underwent TKA using one of the five most common brands of implant. These included Biomet Vanguard (Zimmer Biomet, Warsaw, Indiana) in 211 patients, DePuy/Johnson & Johnson Sigma (DePuy Synthes, Raynham, Massachusetts) in 222, Exactech Optetrak Logic (Exactech, Gainesville, Florida) in 1508, Smith & Nephew Genesis II (Smith & Nephew, London, United Kingdom) in 1415, and Zimmer NexGen (Zimmer Biomet) in 779 patients. Patients were evaluated preoperatively using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lower Extremity Activity Scale (LEAS), and 12-Item Short-Form Health Survey questionnaire (SF-12). Demographics including age, body mass index, Charlson Comorbidity Index, American Society of Anethesiologists status, sex, and smoking status were collected. Postoperatively, two-year KOOS, LEAS, SF-12, and satisfaction scores were compared between groups.ResultsOutcomes were available for 4069 patients (98%) at two years postoperatively. In multiple regression analysis, which separately compared each implant group with the aggregate of all others, there were no clinically significant differences in the change of KOOS score from baseline to two-year follow-up between any of the groups. More than 80% of patients in each group were satisfied at this time in all domains. In a multivariate regression model, patients in the NexGen group were the most likely to be satisfied (odds ratio (OR) 1.63; p = 0.006) and Optetrak Logic patients were the least likely to be satisfied (OR 0.60; p < 0.001).ConclusionTKA provides improvement in function and satisfaction regardless of the type of implant. We could not demonstrate superiority of one design above others across these groups of implants, and any price premium for one above the other systems may not be justified. Healthcare administrators may find these similarities in outcomes helpful when negotiating purchasing contracts. Cite this article: Bone Joint J 2019;101-B(7 Supple C):48–54

The impact of older age on patient outcomes following primary total knee arthroplasty

2018 ◽  
Vol 100-B (11) ◽  
pp. 1463-1470 ◽  
Author(s):  
B. P. d’S. Murphy ◽  
M. M. Dowsey ◽  
T. Spelman ◽  
P. F. M. Choong
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Short Form ◽  
Primary Total Knee Arthroplasty ◽  
Medical Complications ◽  
Meaningful Improvement ◽  
Younger Patients ◽  
Total Knee ◽  
The Impact ◽  
Complications And Mortality

AimsAs the population ages, there is projected to be an increase in the level of demand for total knee arthroplasty (TKA) in octogenarians. We aimed to explore whether those aged ≥ 80 years achieved similar improvements in physical function to younger patients while also comparing the rates of length of stay (LOS), discharge to rehabilitation, postoperative complications, and mortality following TKA in older and younger patients.Patients and MethodsPatients from one institution who underwent primary elective TKA between 1 January 2006 and 31 December 2014 were dichotomized into those ≥ 80 years old (n = 359) and those < 80 years old (n = 2479) for comparison. Multivariable regression was used to compare the physical status component of the 12-Item Short-Form Health Survey (SF-12), LOS, discharge to rehabilitation, complications, and mortality between the two groups.ResultsBoth age groups demonstrated a clinically meaningful improvement in their self-reported physical health relative to their baseline with no clinically relevant difference noted between them. Being ≥ 80 years old was associated with a 0.58-day increase in LOS and older patients were more likely to be discharged to rehabilitation (odds ratio (OR) 3.06, p < 0.001). Medical complications and mortality were higher in elderly patients (OR 1.92 for complications, p < 0.001; hazard ratio 3.40 for death, p < 0.001). There was no statistically significant association between age group and experiencing a postoperative surgical or wound-related complication.ConclusionThose aged over 80 years achieved a statistically significant lower median SF-12 physical score than the younger group, after adjusting for the preoperative score, but this difference of 4.46 was not considered to be clinically meaningful. However, clinicians should be aware that the elderly are at a higher risk of experiencing longer hospital stays, postoperative medical complications, and mortality. Cite this article: Bone Joint J 2018;100-B:1463–70.

scholarly journals The influence of pre- and perioperative administration of gabapentin on pain 3–4 years after total knee arthroplasty

2018 ◽  
Vol 18 (2) ◽  
pp. 237-245 ◽  
Author(s):  
Kristian Kjær Petersen ◽  
Troels Haxholdt Lunn ◽  
Henrik Husted ◽  
Lars Tambour Hansen ◽  
Ole Simonsen ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Pain Catastrophizing ◽  
Depression Scale ◽  
Psychological State ◽  
Chronic Postoperative Pain ◽  
Preoperative Pain ◽  
Pain Scores ◽  
Total Knee

AbstractBackground and aims:Approximately 20% of patients having total knee arthroplasty (TKA) will experience chronic postoperative pain. Recently, preoperative pain facilitation has been associated with chronic pain after TKA, and gabapentin has been shown to decrease pain facilitation. The current study is a secondary follow-up of a primary RCT investigating the effect of gabapentin on acute postoperative pain after TKA and exploring the effect of pre- and perioperative administration of gabapentin on chronic postoperative pain and psychological state 3–4 years after TKA.Methods:Patients scheduled for TKA were randomized to either gabapentin 1,300 mg/day, gabapentin 900 mg/day, or placebo daily from 2-h before and 6 days after operation. Pre- and 3–4 years postoperatively pain scores related to pain while walking, at rest, when flexing the hip or the knee were collected. At the same time, the pain catastrophizing scale (PCS) and hospital anxiety and depression scale subscales for anxiety (HADS-A) and depression (HADS-D) were collected.Results:Lower postoperative pain while walking, flexing the hip, and at rest were found compared with preoperative scores (p<0.03), but these were not associated with gabapentin treatment (p>0.19). Significantly lower postoperative PCS and HADS-A scores were seen compared with preoperative scores (p<0.001), but these were not associated with gabapentin treatment (p>0.55).Conclusions:The current study found that pre- and perioperative administrations of gabapentin do not influence the pain or psychological state 3–4 years after TKA.Implications:The current study does not support that short-term pre- and perioperative use of gabapentin can reduce the development of chronic postoperative pain after TKA.

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