scholarly journals Post-operative patient-related risk factors for chronic pain after total knee replacement: a systematic review

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018105 ◽  
Author(s):  
Vikki Wylde ◽  
Andrew D Beswick ◽  
Jane Dennis ◽  
Rachael Gooberman-Hill
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Chronic Pain ◽  
Total Knee Replacement ◽  
Potential Risk ◽  
Insufficient Evidence ◽  
Postoperative Patient ◽  
Related Factors ◽  
Related Risk ◽  
Total Knee

ObjectiveTo identify postoperative patient-related risk factors for chronic pain after total knee replacement (TKR).DesignThe systematic review protocol was registered on the International Prospective Register of Systematic Reviews (CRD42016041374). MEDLINE, Embase and PsycINFO were searched from inception to October 2016 with no language restrictions. Key articles were also tracked in the Institute for Scientific Information (ISI) Web of Science. Cohort studies evaluating the association between patient-related factors in the first 3 months postoperatively and pain at 6 months or longer after primary TKR surgery were included. Screening, data extraction and assessment of methodological quality were undertaken by two reviewers. The primary outcome was pain severity in the replaced knee measured with a patient-reported outcome measure at 6 months or longer after TKR. Secondary outcomes included adverse events and other aspects of pain recommended by the core outcome set for chronic pain after TKR.ResultsAfter removal of duplicates, 16 430 articles were screened, of which 805 were considered potentially relevant. After detailed evaluation of full-text articles, 14 studies with data from 1168 participants were included. Postoperative patient-related factors included acute pain (eight studies), function (five studies) and psychosocial factors (four studies). The included studies had diverse methods for assessment of potential risk factors and outcomes, and therefore narrative synthesis was conducted. For all postoperative factors, there was insufficient evidence to draw firm conclusions about the association with chronic pain after TKR. Selection bias was a potential risk for all studies, as none were reported to be conducted at multiple centres.ConclusionThis systematic review found insufficient evidence to draw firm conclusions about the association between any postoperative patient-related factors and chronic pain after TKR. Further high-quality research is required to provide a robust evidence base on postoperative risk factors, and inform the development and evaluation of targeted interventions to optimise patients’ outcomes after TKR.

Chronic pain after bilateral thoracotomy in lung transplant patients

2019 ◽  
Vol 19 (2) ◽  
pp. 271-277 ◽  
Author(s):  
Pernille L. Petersen ◽  
Pia Bredahl ◽  
Michael Perch ◽  
Christian H. Møller ◽  
Nanna B. Finnerup ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Lung Transplant ◽  
Spontaneous Pain ◽  
Related Factors ◽  
Transplant Patients ◽  
Relative Contribution ◽  
Transplant Program ◽  
Related Risk ◽  
Two Sides

Abstract Background and aims The relative contribution of patient-related factors and intraoperative nerve damage for the development of chronic pain after surgery is unclear. This study aimed to examine chronic pain after bilateral thoracotomy. We hypothesized, that individual patient-related risk factors would be important resulting in an intraindividual uniformity of pain and hyperphenomena between the two sides of the thorax. Methods Twenty patients who had undergone lung transplantation via bilateral thoracotomy 6–12 months previously were included from the Danish Lung Transplant program, Rigshospitalet, Denmark, from October 2016 to August 2017. All patients answered questionnaires about pain in and around the scar, completed the Neuropathic Pain Symptom Inventory, and underwent bedside examination for hyperphenomena (brush- and cold-evoked allodynia, pinprick hyperalgesia) and pinprick hypoalgesia. Results Nine patients reported spontaneous pain bilaterally, five patients had pain on one side only, and six patients had no pain. Hyperphenomena were present on both sides of the thorax in 13 patients, on one side in four patients, and three patients had no hyperphenomena. The intraindividual uniformity of pain (p=0.029) and hyperphenomena (p=0.011) between the two sides of the thorax suggests that patient-related factors play an important role in the development of chronic pain. Conclusions The results of the present study provide support for the hypothesis of an individual predisposition for the development of chronic pain after thoracotomy. Implications Patient-related risk factors contribute to the development of chronic pain after thoracotomy. This result most likely can be transferred to chronic pain after other surgical procedures and therefore help us understand risk factors for chronic pain after surgery.

scholarly journals A Systematic Review of the Effectiveness of Rehabilitation Therapy to Treat People with Chronic Knee Pain Following A Total Knee Replacement.

2020 ◽  
Author(s):  
Nathan Adam Johns ◽  
Justine Naylor ◽  
Brinda Thirugnanam ◽  
Dean Mckenzie ◽  
Bernadette Brady ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Chronic Pain ◽  
Total Knee Replacement ◽  
Knee Pain ◽  
Knee Replacement ◽  
Chronic Knee Pain ◽  
Total Knee ◽  
Full Text Screening

Abstract Background:Chronic knee pain after a total knee replacement has been estimated to affect 10 to 30% of patients and is related to dissatisfaction with surgery, reduced function and reduced quality of life. Rehabilitation is often prescribed in the subacute period post-operatively, but it may offer benefit to the increasing numbers of patients with chronic pain after their knee replacement. The aim of this systematic review is to evaluate the effectiveness of rehabilitation to improve pain, function and quality of life in people with chronic knee pain persisting for more than 3 months following a total knee replacement.Methods: The systematic review was conducted following PRISMA guidelines with a search of the online databases Ovid Medline, Embase via Ovid, CINAHL Plus, PsycINFO, Ovid Emcare and Proquest from their earliest date to July 12, 2020. The search criteria included English language randomised controlled trials of rehabilitation strategies in any setting to treat people with chronic knee pain, defined as knee pain persisting for more than 3 months, following a total knee replacement. Rehabilitation programs included exercise therapy, patient education, cognitive and mind-body strategies and self-management and excluded medication trials, procedural techniques and complementary therapies. Results:There were 254 abstracts screened for eligibility with 13 remaining for full-text screening. Following full-text screening, there were no studies that met the eligibility criteria for evaluating rehabilitation therapy to treat chronic knee pain persisting for more than 3 months following a total knee replacement.Conclusion:Despite the high volume of knee replacement surgery and the high incidence of moderate to severe chronic pain ensuing, there is currently no evidence available that rehabilitation commencing three months after surgery can effectively treat chronic pain and disability following a total knee replacement.

scholarly journals Effectiveness of postdischarge interventions for reducing the severity of chronic pain after total knee replacement: systematic review of randomised controlled trials

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e020368 ◽  
Author(s):  
Vikki Wylde ◽  
Jane Dennis ◽  
Rachael Gooberman-Hill ◽  
Andrew David Beswick
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Total Knee Replacement ◽  
Randomised Controlled Trials ◽  
Risk Of Bias ◽  
Pain Severity ◽  
Controlled Trials ◽  
Registration Number ◽  
Total Knee ◽  
Randomised Controlled

ObjectiveApproximately 20% of patients experience chronic pain after total knee replacement (TKR). The aim of this systematic review was to evaluate the effectiveness of postdischarge interventions commenced in the first 3 months after surgery in reducing the severity of chronic pain after TKR.DesignThe protocol for this systematic review was registered on PROSPERO (registration number: CRD42017041382). MEDLINE, Embase, CINAHL, PsycINFO and The Cochrane Library were searched from inception to November 2016. Randomised controlled trials of postdischarge intervention which commenced in the first 3 months after TKR surgery were included. The primary outcome of the review was self-reported pain severity at 12 months or longer after TKR. Risk of bias was assessed using the Cochrane risk-of-bias tool.ResultsSeventeen trials with data from 2485 randomised participants were included. The majority of trials evaluated physiotherapy interventions (n=13); other interventions included nurse-led interventions (n=2), neuromuscular electrical stimulation (n=1) and a multidisciplinary intervention (n=1). Opportunities for meta-analysis were limited by heterogeneity. No study found a difference in long-term pain severity between trial arms, with the exception of one trial which found home-based functional exercises aimed at managing kinesiophobia resulted in lower pain severity scores at 12 months postoperatively compared with advice to stay active.ConclusionThis systematic review and narrative synthesis found no evidence that one type of physiotherapy intervention is more effective than another at reducing the severity of chronic pain after TKR. Further research is needed to evaluate non-physiotherapy interventions, including the provision of care as part of a stratified and multidisciplinary care package.PROSPERO registration numberCRD42017041382.

Prevalence of chronic pain and related risk factors in military veterans: a systematic review

2014 ◽  
Vol 12 (10) ◽  
pp. 152-186 ◽  
Author(s):  
Elizabeth G Van Den Kerkhof ◽  
Meg E Carley ◽  
Wilma M Hopman ◽  
Amanda Ross-White ◽  
Margaret B Harrison
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Chronic Pain ◽  
Military Veterans ◽  
Related Risk

scholarly journals Are perioperative interventions effective in preventing chronic pain after primary total knee replacement? A systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e028093 ◽  
Author(s):  
Andrew David Beswick ◽  
Jane Dennis ◽  
Rachael Gooberman-Hill ◽  
Ashley William Blom ◽  
Vikki Wylde
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Adverse Events ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Risk Of Bias ◽  
Low Risk ◽  
Cochrane Library ◽  
Total Knee

ObjectivesFor many people with advanced osteoarthritis, total knee replacement (TKR) is an effective treatment for relieving pain and improving function. Features of perioperative care may be associated with the adverse event of chronic pain 6 months or longer after surgery; effects may be direct, for example, through nerve damage or surgical complications, or indirect through adverse events. This systematic review aims to evaluate whether non-surgical perioperative interventions prevent long-term pain after TKR.MethodsWe conducted a systematic review of perioperative interventions for adults with osteoarthritis receiving primary TKR evaluated in a randomised controlled trial (RCT). We searchedThe Cochrane Library, MEDLINE, Embase, PsycINFO and CINAHL until February 2018. After screening, two reviewers evaluated articles. Studies at low risk of bias according to the Cochrane tool were included.InterventionsPerioperative non-surgical interventions; control receiving no intervention or alternative treatment.Primary and secondary outcome measuresPain or score with pain component assessed at 6 months or longer postoperative.Results44 RCTs at low risk of bias assessed long-term pain. Intervention heterogeneity precluded meta-analysis and definitive statements on effectiveness. Good-quality research provided generally weak evidence for small reductions in long-term pain with local infiltration analgesia (three studies), ketamine infusion (one study), pregabalin (one study) and supported early discharge (one study) compared with no intervention. For electric muscle stimulation (two studies), anabolic steroids (one study) and walking training (one study) there was a suggestion of more clinically important benefit. No concerns relating to long-term adverse events were reported. For a range of treatments there was no evidence linking them with unfavourable pain outcomes.ConclusionsTo prevent chronic pain after TKR, several perioperative interventions show benefits and merit further research. Good-quality studies assessing long-term pain after perioperative interventions are feasible and necessary to ensure that patients with osteoarthritis achieve good long-term outcomes after TKR.

scholarly journals Prevalence of chronic pain and related risk factors in military veterans: a systematic review protocol

2014 ◽  
Vol 12 (2) ◽  
pp. 46-55 ◽  
Author(s):  
Elizabeth G VanDenKerkhof ◽  
Meg E Carley ◽  
Wilma M Hopman ◽  
Amanda Ross-White ◽  
Margaret B Harrison
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Chronic Pain ◽  
Military Veterans ◽  
Systematic Review Protocol ◽  
Related Risk ◽  
Review Protocol

scholarly journals Dislocation after Posterior Stabilized Primary Total Knee Replacement: A Rare Complication in Four Cases

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
W. Spierenburg ◽  
E. L. A. R. Mutsaerts ◽  
J. J. A. M. van Raay
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Case Reports ◽  
Rare Complication ◽  
Varus Deformity ◽  
Related Factors ◽  
Total Knee

Introduction. Dislocation of a total knee arthroplasty is a rare complication that has rarely been described, while the total knee arthroplasty is frequently performed. From literature, we know patient-related factors, like obesity, neuropsychiatric disease, and severe valgus or varus deformity, are associated with higher risk of dislocation. We show our cases for awareness of the risk factors for surgeons. Case Presentations. We present four patients with a dislocation after a total knee arthroplasty. We compare these case reports with previous literature and show the most important risk factors for these dislocations. In our cases, three of them suffered from obesity, which possibly has contributed to the dislocation. Three patients did have instability which emphasizes the importance of ligament balancing while performing a total knee replacement. In all cases, an exchange of the polyethylene liner was performed. Conclusion. Implant-related factors and surgical technique as well as patient-related factors can contribute to this uncommon complication. Obesity, neuropsychiatric disorders, and a severe valgus or varus deformity are important patient-related risk factors. Our cases show these risk factors too. Some of these risk factors were encountered as well as other comorbidity factors. Such risk factors must be taken into consideration when deciding whether to perform a total knee arthroplasty. This stresses the importance of patient education and shared decision-making before performing a total knee replacement.

Sign in / Sign up

Export Citation Format

Share Document