Longitudinal Postoperative Course of Pain and Dysfunction Following Total Knee Arthroplasty

Clin J Pain. 2018 Apr;34(4):332-338. doi: 10.1097/AJP.0000000000000540.

Abstract

Objectives: Although the majority of patients undergoing total knee arthroplasty (TKA) report substantial improvement in pain and function, a significant subset experience persistent postsurgical pain and dysfunction. Better understanding of the longitudinal postoperative course is needed, including the association between patient status following physical rehabilitation at 6-weeks post-TKA, to 6-months outcomes. This study aims to described the postoperative course of TKA and examine variables associated with change in pain and functioning between 6-weeks and 6-months post-TKA.

Methods: In this longitudinal study of 223 participants, assessments of analgesic intake, depression, anxiety, pain catastrophizing, dysfunction, resting and range of motion pain, and pain sensitivity were completed at 6-weeks post-TKA. Analgesic intake, pain ratings, and dysfunction data were also collected at 6-months post-TKA. Pain and dysfunction ratings were divided into none-mild and moderate-severe categories.

Results: Between 6-weeks and 6-months post-TKA, 75% of the sample stayed in the same pain category, 20% improved, and 5% worsened. In terms of functional changes between 6 weeks and 6 months, 65% of the sample stayed in the same functional category, whereas 31% improved and 5% worsened.

Discussion: These findings demonstrate that the majority of patients' pain and functioning remains stable between 6 weeks and 6 months post-TKA. However, a notable subset continues to improve or worsen in pain and functioning and the current study identifies variables associated with these changes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Analgesics / therapeutic use*
  • Anxiety / psychology
  • Arthroplasty, Replacement, Knee*
  • Catastrophization / psychology
  • Depression / psychology
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / physiopathology
  • Osteoarthritis, Knee / surgery*
  • Pain Measurement
  • Pain Threshold
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / physiopathology
  • Pain, Postoperative / psychology
  • Range of Motion, Articular

Substances

  • Analgesics