Possible Neuropathic Pain in Patients With Osteoarthritis of the Knee Before and After Total Knee Arthroplasty

Abstract Background: Although osteoarthritis (OA) is traditionally considered to be nociceptive, our objective was to examine neuropathic pain in the knees of OA patients using the pain DETECT questionnaire (PDQ).Methods: A total of 180 knees in 158 consecutive patients who underwent total knee arthroplasty (TKA) were enrolled. The prevalence of neuropathic pain, unclear pain and nociceptive pain was determined before and after TKA. Knee pain was evaluated using a numerical rating scale (NRS). All patients were evaluated preoperatively and 6 months postoperatively. Neuropathic pain and unclear pain were grouped together as possible neuropathic pain. The relationship between possible neuropathic pain and pain intensity was evaluated.Results: Before TKA, neuropathic pain and unclear pain were found in 10 and 30 knees, respectively. The remaining 140 knees were categorized as nociceptive pain. After TKA, the numbers of knees with neuropathic and unclear pain decreased to one and five, respectively. The prevalence of possible neuropathic pain decreased significantly from 22.2% to 3.3% (p < 0.001) after surgery. Among the six knees with possible neuropathic pain postoperatively, four had possible neuropathic pain preoperatively as well, while the remaining two patients had been classified as nociceptive pain preoperatively (p = 0.021). Knees with postoperative possible neuropathic pain had higher postoperative NRS scores than those with nociceptive pain (p = 0.011).Conclusions: The prevalence of possible neuropathic pain decreased significantly after TKA, however, preoperative possible neuropathic pain might affect the presence of persistent postoperative pain.

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Possible neuropathic pain in patients with osteoarthritis of the knee before and after total knee arthroplasty

10.21203/rs.3.rs-190757/v2 ◽

2021 ◽

Author(s):

Masahiro Hasegawa ◽

Shine Tone ◽

Yohei Naito ◽

Akihiro Sudo

Keyword(s):

Total Knee Arthroplasty ◽

Neuropathic Pain ◽

Knee Arthroplasty ◽

Rating Scale ◽

Numerical Rating Scale ◽

Nociceptive Pain ◽

Osteoarthritis Of The Knee ◽

Before And After ◽

Numerical Rating ◽

Total Knee

Abstract Background: Although osteoarthritis (OA) is traditionally considered to be nociceptive, our objective was to examine neuropathic pain in the knees of OA patients using the painDETECT questionnaire (PDQ).Methods: A total of 180 knees in 158 consecutive patients who underwent total knee arthroplasty (TKA) were enrolled. The prevalence of neuropathic pain, unclear pain and nociceptive pain was determined before and after TKA. Knee pain was evaluated using a numerical rating scale (NRS). All patients were evaluated preoperatively and 6 months postoperatively. Neuropathic pain and unclear pain were grouped together as possible neuropathic pain. The relationship between possible neuropathic pain and pain intensity was evaluated.Results: Before TKA, neuropathic pain and unclear pain were found in 10 and 30 knees, respectively. The remaining 140 knees were categorized as nociceptive pain. After TKA, the numbers of knees with neuropathic and unclear pain decreased to one and five, respectively. The prevalence of possible neuropathic pain decreased significantly from 22.2% to 3.3% (p < 0.001) after surgery. Among the six knees with possible neuropathic pain postoperatively, four had possible neuropathic pain preoperatively as well, while the remaining two patients had been classified as nociceptive pain preoperatively (p = 0.021). Knees with postoperative possible neuropathic pain had higher postoperative NRS scores than those with nociceptive pain (p = 0.011).Conclusions: The prevalence of possible neuropathic pain decreased significantly after TKA, however, preoperative possible neuropathic pain might affect the presence of persistent postoperative pain.

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Prevalence of Persistent Pain after Total Knee Arthroplasty and the Impact of Neuropathic Pain

The Journal of Knee Surgery ◽

10.1055/s-0038-1675415 ◽

2018 ◽

Vol 32 (10) ◽

pp. 1020-1023 ◽

Cited By ~ 1

Author(s):

Masahiro Hasegawa ◽

Shine Tone ◽

Yohei Naito ◽

Hiroki Wakabayashi ◽

Akihiro Sudo

Keyword(s):

Total Knee Arthroplasty ◽

Neuropathic Pain ◽

Knee Arthroplasty ◽

Severe Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Number Of Patients ◽

Numerical Rating ◽

Total Knee ◽

The Impact

AbstractThe present study aimed to define the prevalence of pain persisting after total knee arthroplasty (TKA) and determine the impact of neuropathic pain. Knee pain after TKA was evaluated in 154 patients (222 knees with osteoarthritis) using a numerical rating scale (NRS) and followed up for a mean of 4.7 years. The patients were classified according to whether they had no or mild pain (NRS ≤ 3), or moderate-to-severe pain (NRS > 3), and then assigned to groups with nociceptive, unclear, or neuropathic pain based on responses to painDETECT questionnaires. Risk factors for these types of pain were determined. The ratio of patients with moderate-to-severe pain was 28% (62 knees). Thirteen patients (21 knees; 9%) experienced unclear pain. Patients with moderate-to-severe or unclear pain had malalignment and lower Knee Society knee scores. In conclusion, a significant number of patients experienced moderate-to-severe and unclear pain after TKA. Moderate-to-severe pain was associated with unclear pain.

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Comparison of the postoperative analgesic effect for infiltration between the popliteal artery and the capsule of the posterior knee and that of periarticular multimodal drug injection in total knee arthroplasty: retrospective study in the immediate postoperative period

Knee Surgery and Related Research ◽

10.1186/s43019-019-0025-z ◽

2020 ◽

Vol 32 (1) ◽

Author(s):

Dae-Won Jung ◽

Won-Yong Shon ◽

Seung-Suk Seo ◽

Ok-Gul Kim ◽

In-Seung Lee

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Popliteal Artery ◽

Analgesic Effect ◽

Knee Flexion ◽

Rating Scale ◽

Numerical Rating Scale ◽

Drug Injection ◽

Periarticular Multimodal Drug Injection ◽

Total Knee

Abstract Background The aim of this study is to compare the postoperative analgesic effect of infiltration between the popliteal artery and the capsule of the knee (IPACK) and the effect of periarticular multimodal drug injection (PMDI) in addition to adductor canal block (ACB) after total knee arthroplasty. Methods Among patients who received total knee arthroplasty from June 2017 to December 2017, 50 who underwent ACB with additional IPACK and 50 who received ACB with additional PMDI were selected for this study. We compared the postoperative pain numerical rating scale (NRS), the number of times patient-controlled analgesia was administered and the amount administered, the total amount of opioids given, and complications associated with the procedure between the two groups. Results NRS measured at rest and 45° knee flexion at days 1 and 2 after surgery was significantly lower in the IPACK group than in the PMDI group. The resting NRS measured at day 3 after surgery was also significantly lower in the IPACK group than in the PMDI group, and the NRS at 45° knee flexion measured from day 3 to day 5 showed a significant reduction in the IPACK group. No complications relating to the procedure occurred. Conclusions IPACK may be a better option than PMDI for controlling acute phase pain in patients undergoing total knee arthroplasty.

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Characterization of Patients with Difficult-to-Treat Acute Pain Following Total Knee Arthroplasty Using Multi-Modal Analgesia

The Open Pain Journal ◽

10.2174/1876386301306010001 ◽

2013 ◽

Vol 6 (1) ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Syed A. Azim ◽

Rebecca Sangster ◽

Christine Curcio ◽

Dominick Coleman ◽

Usman Shah ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Pain Control ◽

Rating Scale ◽

Numerical Rating Scale ◽

Femoral Nerve ◽

Post Surgery ◽

Pain Scores ◽

Operative Care ◽

Total Knee

Objective: To determine the efficacy of post-operative pain control over the first 24 hours in patients undergoing unilateral total knee arthroplasty (TKA) using a multi-modal analgesia protocol including femoral nerve catheters (FNC). Materials and Methods: 119 patients who underwent unilateral TKA between 2009 and 2010 under regional anesthesia with FNC were studied. Electronic charts were reviewed for numerical rating scale (NRS) pain scores at baseline, from the time the patients entered the post-operative care unit and every 4 hours thereafter until FNC was discontinued at 24 hours post-surgery. Opioid usage was also recorded during the same time period. Results: Analysis of average NRS pain scores from all patients demonstrated that 69% had NRS pain scores ≤ 5 (‘low pain’ (LP) group) and 31% had NRS pain scores ≥ 6 (‘high pain’ (HP) group). Time analysis showed that HP patients' high pain scores persisted for 24 hours post-surgery and they were characterized by being younger when compared to the LP patients.The majority of HP patients were female. Further analysis demonstrated that the average body mass index (BMI) of the female HP patients was significantly greater than females with LP. Conclusions: In spite of a diverse multi-modal analgesia protocol designed for TKA surgery, 31% of our patients had ‘difficult-to-treat’ pain (NRS pain scores ≥ 6) for 24hours postsurgery. Our analysis implicates age, pre-operative pain scores, female gender and obesity as potential risk factors for experiencing insufficient pain control with the currently evaluated multimodal pain protocol post-TKA surgery.

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FRI0418 SELECTIVE PATELLAR RESURFACING IN TOTAL KNEE ARTHROPLASTY FOR THE OSTEOARTHRITIC KNEE: A PROSPECTIVE STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4074 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 807.3-807

Author(s):

I. Moriyama

Keyword(s):

Total Knee Arthroplasty ◽

Clinical Outcome ◽

Knee Arthroplasty ◽

Patellofemoral Joint ◽

Osteoarthritis Of The Knee ◽

Patellar Resurfacing ◽

Criterion A ◽

Total Knee ◽

The Mean

Background:No widely accepted view or criteria currently exist concerning whether or not patellar replacement (resurfacing) should accompany total knee arthroplasty for osteoarthritis of the knee.1)2)3)Objectives:We recently devised our own criteria for application of patellar replacement and performed selective patellar replacement in accordance with this set of criteria. The clinical outcome was analyzed.Methods:The study involved 1150 knees on which total knee arthroplasty was performed between 2005 and 2019 because of osteoarthritis of the knee. The mean age at operation was 73, and the mean postoperative follow-up period was 91 months. Our criteria for application of patellar replacement are given below. Criterion A pertains to evaluation of preoperative clinical symptoms related to the patellofemoral joint: (a) interview regarding presence/absence of pain around the patella, (b) cracking or pain heard or felt when standing up from a low chair, (c) pain when going upstairs/downstairs. Because it is difficult for individual patients to identify the origin of pain (patellofemoral joint or femorotibial joint), the examiner advised each patient about the location of the patellofemoral joint when checking for these symptoms. Criterion B pertains to intense narrowing or disappearance of the patellofemoral joint space on preoperative X-ray of the knee. Criterion C pertains to the intraoperatively assessed extent of patellar cartilage degeneration corresponding to class 4 of the Outerbridge classification. Patellar replacement was applied to cases satisfying at least one of these sets of criteria (A-a,-b,-c, B and C). Postoperatively, pain of the patellofemoral joint was evaluated again at the time of the last observation, using Criterion A-a,-b,-c.Results:Patellar replacement was applied to 110 knees in accordance with the criteria mentioned above. There were 82 knees satisfying at least one of the Criterion sets A-a,-b,-c, 39 knees satisfying Criterion B and 70 knees satisfying Criterion C. (Some knees satisfied 2 or 3 of Criteria A, B and C).When the pain originating from patellofemoral joint (Criterion A) was clinically assessed at the time of last observation, pain was not seen in any knee of the replacement group and the non-replacement group.Conclusion:Whether or not patellar replacement is needed should be determined on the basis of the symptoms or findings related to the patellofemoral joint, and we see no necessity of patellar replacement in cases free of such symptoms/findings. When surgery was performed in accordance with the criteria on patellar replacement as devised by us, the clinical outcome of the operated patellofemoral joint was favorable, although the follow-up period was not long. Although further follow-up is needed, the results obtained indicate that selective patellar replacement yields favorable outcome if applied to cases judged indicated with appropriate criteria.References:[1]The Effect of Surgeon Preference for Selective Patellar Resurfacing on Revision Risk in Total Knee Replacement: An Instrumental Variable Analysis of 136,116 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry.Vertullo CJ, Graves SE, Cuthbert AR, Lewis PL J Bone Joint Surg Am. 2019 Jul 17;101(14):1261-1270[2]Resurfaced versus Non-Resurfaced Patella in Total Knee Arthroplasty.Allen W1, Eichinger J, Friedman R. Indian J Orthop. 2018 Jul-Aug;52(4):393-398.[3]Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?Maradit-Kremers H, Haque OJ, Kremers WK, Berry DJ, Lewallen DG, Trousdale RT, Sierra RJ. J Arthroplasty. 2017 Apr;32(4):1143-1147.Disclosure of Interests:None declared

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Differential response to scrambler therapy by neuropathic pain phenotypes

Scientific Reports ◽

10.1038/s41598-021-89667-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Young Gi Min ◽

Hyun Seok Baek ◽

Kyoung-Min Lee ◽

Yoon-Ho Hong

Keyword(s):

Neuropathic Pain ◽

Treatment Outcome ◽

Rating Scale ◽

Numerical Rating Scale ◽

Brief Pain Inventory ◽

Differential Response ◽

Open Label ◽

Numerical Rating ◽

Scrambler Therapy ◽

Post Hoc

AbstractScrambler therapy is a noninvasive electroanalgesia technique designed to remodulate the pain system. Despite growing evidence of its efficacy in patients with neuropathic pain, little is known about the clinical factors associated with treatment outcome. We conducted a prospective, open-label, single-arm trial to assess the efficacy and safety of scrambler therapy in patients with chronic neuropathic pain of various etiologies. A post-hoc analysis was performed to investigate whether cluster analysis of the Neuropathic Pain Symptom Inventory (NPSI) profiles could identify a subgroup of patients regarding neuropathic pain phenotype and treatment outcome. Scrambler therapy resulted in a significant decrease in the pain numerical rating scale (NRS) score over 2 weeks of treatment (least squares mean of percentage change from baseline, − 15%; 95% CI − 28% to − 2.4%; p < 0.001). The mean score of Brief Pain Inventory (BPI) interference subdimension was also significantly improved (p = 0.022), while the BPI pain composite score was not. Hierarchical clustering based on the NPSI profiles partitioned the patients into 3 clusters with distinct neuropathic pain phenotypes. Linear mixed-effects model analyses revealed differential response to scrambler therapy across clusters (p = 0.003, pain NRS; p = 0.072, BPI interference subdimension). Treatment response to scrambler therapy appears different depending on the neuropathic pain phenotypes, with more favorable outcomes in patients with preferentially paroxysmal pain rather than persistent pain. Further studies are warranted to confirm that capturing neuropathic pain phenotypes can optimize the use of scrambler therapy.

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Postoperative laxity of the lateral soft tissue is largely negligible in total knee arthroplasty for varus osteoarthritis

Journal of Orthopaedic Surgery ◽

10.1177/23094990211002002 ◽

2021 ◽

Vol 29 (1) ◽

pp. 230949902110020

Author(s):

Seikai Toyooka ◽

Hironari Masuda ◽

Nobuhiro Nishihara ◽

Takashi Kobayashi ◽

Wataru Miyamoto ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Mechanical Axis ◽

Varus Deformity ◽

Varus Knee ◽

Before And After ◽

Knee Deformity ◽

Varus Stress ◽

Total Knee

Purpose: To evaluate the integrity of lateral soft tissue in varus osteoarthritis knee by comparing the mechanical axis under varus stress during navigation-assisted total knee arthroplasty before and after compensating for a bone defect with the implant. Methods: Sixty-six knees that underwent total knee arthroplasty were investigated. The mechanical axis of the operated knee was evaluated under manual varus stress immediately after knee exposure and after navigation-assisted implantation. The correlation between each value of the mechanical axis and degree of preoperative varus deformity was compared by regression analysis. Results: The maximum mechanical axis under varus stress immediately after knee exposure increased in proportion to the degree of preoperative varus deformity. Moreover, the maximum mechanical axis under varus stress after implantation increased in proportion to the degree of preoperative varus deformity. Therefore, the severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, regression coefficients after implantation were much smaller than those measured immediately after knee exposure (0.99 vs 0.20). Based on the results of the regression formula, the postoperative laxity of the lateral soft tissue was negligible, provided that an appropriate thickness of the implant was compensated for the bone and cartilage defect in the medial compartment without changing the joint line. Conclusion: The severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, even if the degree of preoperative varus deformity is severe, most cases may not require additional procedures to address the residual lateral laxity.

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Bone Cement Solidifiliation Influence the Limb Alignment and Gap Balance during TKA

BioMed Research International ◽

10.1155/2015/109402 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Dongquan Shi ◽

Xingquan Xu ◽

Anyun Guo ◽

Jin Dai ◽

Zhihong Xu ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Bone Cement ◽

Knee Arthroplasty ◽

Mechanical Axis ◽

Statistical Significance ◽

Mechanical Alignment ◽

Early Loosening ◽

Flexion Extension ◽

Before And After ◽

Total Knee

Introduction. Mechanical alignment deviation after total knee arthroplasty is a major reason for early loosening of the prosthesis. Achieving optimum cement penetration during fixation of the femoral and tibial component is an essential step in performing a successful total knee arthroplasty. Bone cement is used to solidify the bone and prosthesis. Thickness imbalance of bone cement leads to the deviation of mechanical alignment. To estimate the influence of bone cement, a retrospective study was conducted.Materials and Methods. A total of 36 subjects were studied. All the TKA were performed following the standard surgical protocol for navigated surgery by medial approach with general anaesthesia. Prostheses were fixed by bone cement.Results. We compared the mechanical axis, flexion/extension, and gap balance before and after cementation. All the factors were different compared with those before and after cementation. Internal rotation was reached with statistical significance (P=0.03).Conclusion. Bone cement can influence the mechanical axis, flexion/extension, and gap balance. It also can prompt us to make a change when poor knee kinematics were detected before cementation.

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