Faculty Opinions recommendation of Persistent postoperative pain after total knee arthroplasty: a prospective cohort study of potential risk factors.

2018 ◽  
Author(s):  
Peter John Lee
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Cohort Study ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Potential Risk ◽  
Prospective Cohort ◽  
Potential Risk Factors ◽  
Total Knee ◽  
Persistent Postoperative Pain

scholarly journals Early Pulmonary Complications following Total Knee Arthroplasty under General Anesthesia: A Prospective Cohort Study Using CT Scan

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Kai Song ◽  
Zhen Rong ◽  
Xianfeng Yang ◽  
Yao Yao ◽  
Yeshuai Shen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Cohort Study ◽  
Pleural Effusion ◽  
Blood Transfusion ◽  
Ct Scan ◽  
Knee Arthroplasty ◽  
Prospective Cohort ◽  
Pulmonary Complications ◽  
Total Knee

Purpose.Postoperative pulmonary complications (PPCs) are common after major surgeries. However, the number of studies regarding PPCs following total knee arthroplasty (TKA) is limited. The aim of this study was to determine the incidence of early PPCs following TKA by computed tomography (CT) scan and to identify associated risk factors.Methods.Patients, who were diagnosed with osteoarthritis or rheumatoid arthritis and underwent primary TKA at our institution, were included in this prospective cohort study. Patients received a standard procedure of TKA under general anesthesia. Chest CT scan was performed during 5–7 days postoperatively. Univariate analysis and multivariate logistic regression analysis were employed to identify the risk factors.Results.The total incidence of early PPCs following TKA was 45.9%. Rates of pneumonia, pleural effusion, and atelectasis were 14.4%, 38.7%, and 12.6%, respectively. Lower body mass index and perioperative blood transfusion were independent risk factors for PPCs as a whole and associated with atelectasis. Postoperative acute episode of hypoxemia increased the risk of pneumonia. Blood transfusion alone was related to pleural effusion.Conclusions.The incidence of early PPCs following TKA was high. For patients with relevant risk factors, positive measures should be adopted to prevent PPCs.

Identification of biological risk factors for persistent postoperative pain after total knee arthroplasty

2021 ◽  
pp. rapm-2021-102953
Author(s):  
Alexandra Sideris ◽  
Michael-Alexander Malahias ◽  
George Birch ◽  
Haoyan Zhong ◽  
Valeria Rotundo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Synovial Fluid ◽  
Knee Arthroplasty ◽  
Persistent Pain ◽  
Patient Specific ◽  
Multiple Time ◽  
Cytokine Levels ◽  
Total Knee ◽  
Persistent Postoperative Pain

BackgroundThere is growing evidence that cytokines and adipokines are associated with osteoarthritis (OA) severity, progression, and severity of associated pain. However, the cytokine response to total knee arthroplasty (TKA) and its association with persistent postoperative pain is not well understood. This study aims to describe the perioperative systemic (plasma) and local (synovial fluid) cytokine profiles of patients who do and do not develop persistent pain after TKA.MethodsPatients undergoing primary unilateral TKA for end-stage OA were prospectively enrolled. Demographic and clinical data were gathered preoperatively and postoperatively. Synovial fluid was collected pre arthrotomy and plasma was collected at multiple time points before and after surgery. Persistent postoperative pain (PPP) was defined as Numerical Rating Score≥4 at 6 months. Cytokine levels were measured using the V-Plex Human Cytokine 30-Plex Panel (Mesoscale—Rockville, Maryland, USA). Cytokine levels were compared between PPP and minimal pain groups. Given that the study outcomes are exploratory, no adjustment was performed for multiple testing.ResultsIncidence of persistent pain at 6 months post TKA was 15/162 (9.3%). Postoperative plasma levels of four cytokines were significantly different in patients who developed persistent postoperative pain: interleukin (IL)-10, IL-1β, vascular endothelial growth factor, and IL12/IL23p40. Significantly lower IL-10 levels in the prearthrotomy synovial fluid were associated with development of postoperative persistent pain.ConclusionsThis prospective cohort study described a distinct acute perioperative inflammatory response profile in patients who developed persistent post-TKA pain, characterized by significant differences in four cytokines over the first 2 postoperative days. These results support the growing evidence that the patient-specific biologic response to surgery may influence longer-term clinical outcomes after TKA.Trial registration numberClinicaltrials.gov NCT02626533.

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