Abstract
ObjectivesUnrelieved postoperative pain after total knee arthroplasty (TKA) is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA.MethodsPrior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD) 0 to 4. Clinical data were extracted from medical records.ResultsSeveral factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA) were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery.DiscussionPatients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients’ perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes.
Highlights
Several factors were associated with higher levels of preoperative and postoperative pain
Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4
Lower perceived consequences of OA were associated with higher pain from POD1 to POD4
Summary
12% of adults over 60 years of age suffer from symptomatic osteoarthritis (OA) of the knee [1]. Living with OA is associated with chronic pain, disability, fatigue, depressed mood, and decreased quality of life [2, 3]. More than 50% of adults diagnosed with knee OA undergo total knee arthroplasty (TKA) [4] in order to relieve pain and improve function. TKA is an extremely painful procedure [5,6,7] and postoperative pain is not well managed [6]. Undertreatment of postoperative pain is associated with a higher risk of pulmonary and cardiac complications [8, 9], delayed recovery, and subsequent development of chronic postsurgical pain [10, 11]
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