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Screening to identify postoperative pain and cross-sectional associations between factors identified in this process with pain and function, three months after total knee replacement

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Wylde, Vikki, Sanderson, Emily, Peters, Tim J., Bertram, Wendy, Howells, Nicholas, Bruce, Julie, Eccleston, Christopher and Gooberman-Hill, Rachael (2022) Screening to identify postoperative pain and cross-sectional associations between factors identified in this process with pain and function, three months after total knee replacement. Arthritis Care & Research, 74 (5). pp. 790-798. doi:10.1002/acr.24516 ISSN 2151-464X.

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Official URL: https://doi.org/10.1002/acr.24516

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Abstract

Objectives: Describe the screening and recruitment process of a randomised trial and evaluate associations with knee pain and function three months after total knee replacement (TKR).

Methods: To screen for a multi-centre trial, 5036 patients were sent an Oxford Knee Score (OKS) questionnaire 10 weeks post-TKR. Patients who reported pain in their replaced knee (≤14 on OKS pain component), completed a second OKS 12 weeks post-TKR. Those still experiencing pain 12 weeks post-TKR completed a detailed questionnaire 13 weeks post-TKR. These data were used to characterise pain in a cross-sectional analysis. Multivariable regression was performed, identifying factors associated with pain and function at 13 weeks post-TKR.

Results: We received OKS questionnaires from 3058/5063 (60%) TKR patients, 907/3058 (30%) reported pain in their replaced knee 10-weeks post-operatively. By 12-weeks, 179/553 (32%) patients reported improved pain (OKS>14). At 13-weeks, 192/363 (53%) who completed a detailed questionnaire reported neuropathic pain, 94/362 (26%) reported depression symptoms and 95/363 (26%) anxiety symptoms. More severe pain at 13-weeks post-operatively was associated with poorer general health, poorer physical health, more pain worry and lower satisfaction with surgery outcome. More severe functional limitation was associated with higher levels of depression, more pain worry, lower satisfaction with surgery outcome and higher pain acceptance.

Conclusions: Screening after TKR identified people with pain. We identified several potential targets (physical and mental health outcomes, acceptance of pain and quality of life) for tailored intervention to improve outcomes for patients. Trials of multidisciplinary interventions are now needed.

Item Type: Journal Article
Subjects: R Medicine > RD Surgery
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Total knee replacement, Knee -- Surgery, Chronic pain, Central pain, Neuralgia, Nervous system -- Pathophysiology, Postoperative care
Journal or Publication Title: Arthritis Care & Research
Publisher: Wiley-Blackwell Publishing Ltd.
ISSN: 2151-464X
Official Date: May 2022
Dates:
DateEvent
May 2022Published
18 November 2020Available
9 November 2020Accepted
Volume: 74
Number: 5
Page Range: pp. 790-798
DOI: 10.1002/acr.24516
Status: Peer Reviewed
Publication Status: Published
Reuse Statement (publisher, data, author rights): "This is the peer reviewed version of the following article: Wylde, V., Sanderson, E., Peters, T.J., Bertram, W., Howells, N., Bruce, J., Eccleston, C. and Gooberman‐Hill, R. (2020), Screening to identify postoperative pain and cross‐sectional associations between factors identified in this process with pain and function, three months after total knee replacement. Arthritis Care & Research. Accepted Author Manuscript., which has been published in final form at https://doi.org/10.1002/acr.24516. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions."
Access rights to Published version: Open Access (Creative Commons)
Description:

Accepted version OA online early but no license

Date of first compliant deposit: 12 November 2020
Date of first compliant Open Access: 18 November 2021
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
RP-PG-0613-20001[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
UNSPECIFIEDNIHR Bristol Biomedical Research CentreUNSPECIFIED
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