Persistent post-surgical pain and neuropathic pain after total knee replacement

Table 1 Total knee replacement and chronic (persistent) post-surgical pain

Ref.	Design/patients	Aim of the study	Scores-scales	Follow-up	Pain	Factors
Brander et al[19]	Prospective n = 116	To describe the natural history of pain after TKR To identify factors predicting excessive post-surgical pain	VAS and other measures of patient health	Pre-op. Post-op.: (1) 1 mo; (2) 3 mo; (3) 6 mo; and (4) 12 mo	Pre-op.: 72.3% Post op.: (1) 44.4%; (2) 22.6%; (3) 18.4%; and (4) 13.1%, respectively	Factors related with post-op pain at 12 mo (1) Pre-operative pain; and (2) Pre-operative depression and anxiety
Forsythe et al[20]	Prospective n = 55	To document: the prospective pain experience following TKR To determine if: (1) comorbidities; (2) preoperative pain; or (3) preoperative pain catastrophizing scores are predictors of chronic pain after TKR	MPQ PCS	Pre-op. Post-op.: (1) 3 mo; (2) 12 mo; and (3) 24 mo	Significant reduction only between pre-op and 3-mo post-op values. After 3-mo pain had reached a plateau Pain catastrophizing scores didn’t show any significant differences	Predictive of chronic postoperative pain: (1) No. of comorbidities; and (2) Pre-operative pain catastrophizing scores
Ritter et al[24]	Retrospective n = 7326	To quantify the effect of sex on the clinical outcome and survivorship of a specific TKR (AGC, Biomet, Warsaw, Ind)	KSS PS FS	Clinical scores: Throughout 5 yr Survival data: Up to 17 yr	Pain after TKR was less for men but there was no statistically significant difference between men and women	Improvement after TKR is similar for men and women No significant difference in post-operative pain between men and women
Wylde et al[9]	Retrospective n = 632	To assess the (1) prevalence; (2) severity; (3) sensory qualities; and (4) postoperative determinants of persistent pain after primary THR and TKR	WOMAC Pain Scale SFMPQ pD-Q Two-item Patient Health Questionnaire (PHQ-2)	Median: 41 mo Range: 34-49 mo	Persistent post-surgical pain (PPSP): 44% Severe-extreme PPSP: 15% Constant PPSP: 5% Likely neuropathic pain: 6%	Significant and independent postoperative determinants of number of PPSP: (1) No. of pain problems elsewhere; and (2) The presence of major depression
Polkowski et al[23]	Prospective n = 309	To explore the relationship between early-grade preoperative OA with pain and dissatisfaction after TKR	Group A: Pain after TKR Group B: Consecutive series of 100 TKR’s performed the same period by the same surgeon Group C: Asymptomatic TKR Group D: Symptomatic TKR performed the same period	1-5 yr	Early-grade OA pre-op: Group A: 49% Group B: 5% Group C: 6% Group D: 10%.	A high percentage of patients referred for unexplained pain after TKR had early-grade OA pre-operatively
Noiseux et al[21]	Prospective n = 215	Τo discover whether any preoperative assessment could predict high pain scores and functional limitations postoperatively	Pain Intensity rating: NRS QST Anxiety Form of the State Trait Anxiety Inventory GDS PCS	Pre-op. Post-op.: 6 mo	Moderate to severe pain At rest: Pre-op.: 17% Post-op.: 5% With range-of-motion: Pre-op.: 52% Post-op.: 16%	Significant predictors (for moderate or severe TKR pain with knee motion after 6 mo): (1) Severe preoperative knee pain with range-of motion; and (2) Anxiety
Pérez-Prieto et al[22]	Prospective n = 716 Depressed: n = 200	To evaluate quality of life, function, pain and satisfaction outcomes in patients, with and without depression, undergoing TKR	GDS KSS Medical Outcomes Study 36-Item Short Form Health (SF-36) MCS VAS	12 mo	Depressed patients reported significant higher pain scores than non-depressed patients pre- and post-operatively Net changes (postoperative - preoperative): No significant difference	Depression leads to (1) Poorer preoperative and postoperative scores in all but the mental domains; and (2) But similar net score changes (improvement) with a high rate of patient satisfaction
W-Dahl et al[25]	Non-depressed: n = 516 retrospective	To evaluate how the instruments used to measure pain affected the number of patients who reported no relief of pain or worse pain, and the relative effect of potential risk factors	Osteoarthritis Outcome Score (KOOS) VAS EQ-5D	Pre-operatively 1 year post-operatively	No pain relief: 10.1% Only KOOS pain: 25% Only VAS knee pain: 52% Both: 23%	The observed proportion of patients with unchanged or worse pain one year after TKR differed depending on the method of pain measurement used Risk factors for no pain relief are: (1) less pre-operative pain; and (2) higher degree of anxiety Charnley category C was a risk factor for unchanged or worse pain as measured by the VAS but not for the KOOS

OA: Osteoarthritis; TKR: Total knee replacement; Pre-op: Preoperatively; Post-op: Postoperatively; PPSP: Persistent post-surgical pain; VAS: Visual Analogue Scale; EQ-5D: Euro-Qol 5 Dimension; MCS: Mental Composite Score; KSS: Knee Society Score; GDS: Geriatric Depression Scale; PCS: Pain Catastrophizing Scale; QST Quantitative Sensory Testing; NRS: Numerical Rating Scale; SFMPQ: Short-Form McGill Pain Questionnaire; pD-Q: PainDETECT Questionnaire; WOMAC: Western Ontario and McMaster Universities Index of Osteoarthritis; FS: Function score; PS: Pain score; KSS: Knee Society knee score; MPQ: McGill Pain Questionnaire.