Abstract
ObjectivesOne in five patients does not improve in pain with walking (non-responders) 12 months after total knee arthroplasty (TKA). This longitudinal study investigated a broad range of symptoms before and after TKA and evaluated possible differences in symptom distress between responders and non-responders with regards to pain with walking after TKA.MethodsPrior to TKA surgery, 182 patients completed a demographic questionnaire and the Memorial Symptom Assessment Scale—Short Form (MSAS-SF). The MSAS-SF was repeated 12 months following TKA. Clinical data were extracted from medical records. Patients were categorized as responders or non-responders based on their trajectories of pain with walking assessed prior to surgery, on postoperative day 4, at 6 weeks, and at 3 and 12 months.ResultsOverall, the most distressful preoperative symptoms were pain, lack of energy, difficulty sleeping, feeling drowsy, worrying, feeling bloated, and problems with sexual interest or activity. However, compared with patients classified as responders to TKA, non-responders had higher total symptom distress scores both preoperatively and 12 months postoperatively. Preoperatively, non-responders scored higher than responders on five of the seven most distressing symptoms (i.e., all except difficulty sleeping and feeling bloated), and 12 months postoperatively, non-responders scored higher than responders on six of the seven most distressing symptoms (i.e., all but feeling bloated). In a multivariate analysis, higher preoperative distress scores for pain and problems with sexual interest or activity were significant predictors of non-response to TKA, controlling for other relevant factors.ConclusionsPatients’ preoperative symptom burden may be a useful indicator of their risk for non-improvement following TKA surgery. Future studies need to evaluate the effect of reducing patients’ preoperative symptom burden on TKA outcomes.
Highlights
Total knee arthroplasty (TKA) is a common procedure to reduce pain and improve functioning among patients with advanced osteoarthritis (OA) when non-surgical treatment no longer proves effective
In a meta-analysis that investigated a variety of studies on different factors and their relationship to persistent pain after TKA, symptoms and psychosocial characteristics were more frequently identified as risk factors, compared to demographic, perioperative or biomechanical factors [4]
No studies have investigated a broad range of symptoms before and after TKA and evaluated their relationship to TKA outcomes. To address this gap in knowledge and to achieve a better understanding of the factors that may be contributing to non-improvement following TKA, this study aims to investigate a broad list of symptoms that include somatic and psychological symptoms, which may or may not be related to the patients’ OA condition
Summary
Total knee arthroplasty (TKA) is a common procedure to reduce pain and improve functioning among patients with advanced osteoarthritis (OA) when non-surgical treatment no longer proves effective. While the procedure is highly successful for most patients, approximately 20% do not experience reduced pain with walking 12 months after TKA and continue to report pain [3]. Patients with knee OA may experience more general symptoms, and the presence and distress of certain symptoms may be risk factors for a poor outcome following TKA. Higher preoperative pain and multiple painful sites are considered risk factors for acute [9] and persistent pain following TKA [4]. Patients with less preoperative pain have better postoperative outcomes, they report less improvement than patients with higher preoperative pain levels [10]
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