Anesth Pain Med.  2019 Oct;14(4):480-488. 10.17085/apm.2019.14.4.480.

Association of preoperative pain in knee and external to knee with postoperative pain outcome after total knee arthroplasty

• Oh TK
• Chang CB
• Shin HJ
• Han S
• Do SH
• Cho HH
• Hwang JW

• KMID: 2465349
• DOI: http://doi.org/10.17085/apm.2019.14.4.480

Abstract

BACKGROUND
Preoperative pain in the symptomatic knee may predict postoperative pain severity in patients undergoing total knee arthroplasty (TKA). However, the effect of preoperative pain external to the knee on postoperative pain is unclear. This study evaluated postoperative pain outcomes in TKA patients according to the presence of preoperative pain in the knee only or in the knee and external to the knee.
METHODS
We retrospectively assessed medical records of patients who underwent unilateral TKA. The relationship between reported preoperative pain characteristics and morphine equivalent consumption or numerical rating scale (NRS) pain scores on postoperative day (POD) 0-3 was assessed using a multivariable generalized linear model.
RESULTS
In total, 3,429 adult patients who underwent their first TKA were included; 2,864 (83.5%) patients preoperatively experienced only knee pain and 565 (16.5%) knee pain with external to knee pain. Preoperative pain in the knee and external to the knee was associated with 5% higher morphine equivalent consumption on POD 0-3 compared to preoperative knee pain only (exponentiated regression coefficient: 1.05; 95% confidence interval: 1.02 to 1.09; P = 0.004). However, the NRS pain scores on POD 0, 1, 2, and 3 and adjuvant analgesics consumption (acetaminophen and ketorolac) on POD 0-3 were not significantly different between the two groups (P > 0.05).
CONCLUSIONS
This study showed that there was an increase of morphine equivalent consumption during POD 0-3 in patients with preoperative knee pain with external to knee pain than in patients with preoperative only knee pain.

Keyword

Analgesics, opioid; Arthralgia; Pain, postoperative

MeSH Terms

Adult
Analgesics
Analgesics, Opioid
Arthralgia
Arthroplasty, Replacement, Knee*
Humans
Knee*
Linear Models
Medical Records
Morphine
Pain, Postoperative*
Retrospective Studies
Analgesics
Analgesics, Opioid
Morphine

Figure

• 

  Fig. 1 Flow chart for patient selection. TKA: total knee arthroplasty, POD: postoperative day.

Reference

1. Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am. 2015; 97:1386–97. DOI: 10.2106/JBJS.N.01141. PMID: 26333733. PMCID: PMC4551172.

2. Brander V, Stulberg SD. Rehabilitation after hipand knee-joint replacement An experienceand evidence-based approach to care. Am J Phys Med Rehabil. 2006; 85(11 Suppl):98–118. quiz S119-23. DOI: 10.1097/01.phm.0000245569.70723.9d. PMID: 17079984.

3. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis?A systematic review of prospective studies in unselected patients. BMJ Open. 2012; 2:e000435. DOI: 10.1136/bmjopen-2011-000435. PMID: 22357571. PMCID: PMC3289991.

4. Puolakka PA, Rorarius MG, Roviola M, Puolakka TJ, Nordhausen K, Lindgren L. Persistent pain following knee arthroplasty. Eur J Anaesthesiol. 2010; 27:455–60. DOI: 10.1097/EJA.0b013e328335b31c. PMID: 20299989.

5. Teichtahl AJ, Wluka AE, Proietto J, Cicuttini FM. Obesity and the female sex, risk factors for knee osteoarthritis that may be attributable to systemic or local leptin biosynthesis and its cellular effects. Med Hypotheses. 2005; 65:312–5. DOI: 10.1016/j.mehy.2005.02.026. PMID: 15922106.

6. Imamura M, Imamura ST, Kaziyama HH, Targino RA, Hsing WT, de Souza LP, et al. Impact of nervous system hyperalgesia on pain, disability, and quality of life in patients with knee osteoarthritis:a controlled analysis. Arthritis Rheum. 2008; 59:1424–31. DOI: 10.1002/art.24120. PMID: 18821657.

7. Lee YC, Lu B, Bathon JM, Haythornthwaite JA, Smith MT, Page GG, et al. Pain sensitivity and pain reactivity in osteoarthritis. Arthritis Care Res (Hoboken). 2011; 63:320–7. DOI: 10.1002/acr.20373. PMID: 20957660. PMCID: PMC3030930.

8. Schaible HG. Spinal mechanisms contributing to joint pain. No-vartis Found Symp. 2004; 260:4–22. discussion 22-7, 100-4, 277-9. PMID: 15283441.

9. Nie H, Graven-Nielsen T, Arendt-Nielsen L. Spatial and temporal summation of pain evoked by mechanical pressure stimulation. Eur J Pain. 2009; 13:592–9. DOI: 10.1016/j.ejpain.2008.07.013. PMID: 18926745.

10. Staud R, Koo E, Robinson ME, Price DD. Spatial summation of mechanically evoked muscle pain and painful aftersensations in normal subjects and fibromyalgia patients. Pain. 2007; 130:177–87. DOI: 10.1016/j.pain.2007.03.015. PMID: 17459587. PMCID: PMC2041939.

11. Kim MH, Nahm FS, Kim TK, Chang MJ, Do SH. Comparison of postoperative pain in the first and second knee in staged bilateral total knee arthroplasty:clinical evidence of enhanced pain sensitivity after surgical injury. Pain. 2014; 155:22–7. DOI: 10.1016/j.pain.2013.08.027. PMID: 23994101.

12. D'Hoore W, Sicotte C, Tilquin C. Risk adjustment in outcome assessment:the Charlson comorbidity index. Methods Inf Med. 1993; 32:382–7. DOI: 10.1055/s-0038-1634956. PMID: 8295545.

13. Derby SA. Opioid conversion guidelines for managing adult cancer pain. Am J Nurs. 1999; 99:62–5. DOI: 10.1097/00000446-199910000-00053. PMID: 10542852.

14. Lluch E, Torres R, Nijs J, Van Oosterwijck J. Evidence for central sensitization in patients with osteoarthritis pain:a systematic literature review. Eur J Pain. 2014; 18:1367–75. DOI: 10.1002/j.1532-2149.2014.499.x. PMID: 24700605.

15. Fingleton C, Smart K, Moloney N, Fullen BM, Doody C. Pain sensitization in people with knee osteoarthritis:a systematic review and meta-analysis. Osteoarthritis Cartilage. 2015; 23:1043–56. DOI: 10.1016/j.joca.2015.02.163. PMID: 25749012.

16. Rakel BA, Blodgett NP, Bridget Zimmerman M, Logsden-Sackett N, Clark C, Noiseux N, et al. Predictors of postoperative movement and resting pain following total knee replacement. Pain. 2012; 153:2192–203. DOI: 10.1016/j.pain.2012.06.021. PMID: 22840570. PMCID: PMC3472094.

17. Staud R, Vierck CJ, Cannon RL, Mauderli AP, Price DD. Abnormal sensitization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome. Pain. 2001; 91:165–75. DOI: 10.1016/S0304-3959(00)00432-2. PMID: 11240089.

18. Staud R. Abnormal endogenous pain modulation is a shared characteristic of many chronic pain conditions. Expert Rev Neurother. 2012; 12:577–85. DOI: 10.1586/ern.12.41. PMID: 22550986. PMCID: PMC3373184.

19. Julien N, Goffaux P, Arsenault P, Marchand S. Widespread pain in fibromyalgia is related to a deficit of endogenous pain inhibition. Pain. 2005; 114:295–302. DOI: 10.1016/j.pain.2004.12.032. PMID: 15733656.

20. Ossipov MH, Dussor GO, Porreca F. Central modulation of pain. J Clin Invest. 2010; 120:3779–87. DOI: 10.1172/JCI43766. PMID: 21041960. PMCID: PMC2964993.

21. Graven-Nielsen T, Wodehouse T, Langford RM, Arendt-Nielsen L, Kidd BL. Normalization of widespread hyperesthesia and facilitated spatial summation of deep-tissue pain in knee osteoarthritis patients after knee replacement. Arthritis Rheum. 2012; 64:2907–16. DOI: 10.1002/art.34466. PMID: 22421811.

22. Lluch Girbés E, Dueñas L, Barbero M, Falla D, Baert IA, Meeus M, et al. Expanded distribution of pain as a sign of central sensitization in individuals with symptomatic knee osteoarthritis. Phys Ther. 2016; 96:1196–207. DOI: 10.2522/ptj.20150492. PMID: 26939604.

23. Wylde V, Sayers A, Lenguerrand E, Gooberman-Hill R, Pyke M, Beswick AD, et al. Preoperative widespread pain sensitization and chronic pain after hip and knee replacement:a cohort analysis. Pain. 2015; 156:47–54. DOI: 10.1016/j.pain.0000000000000002. PMID: 25599300. PMCID: PMC4280282.

24. Wylde V, Sayers A, Odutola A, Gooberman-Hill R, Dieppe P, Blom AW. Central sensitization as a determinant of patients'benefit from total hip and knee replacement. Eur J Pain. 2017; 21:357–65. DOI: 10.1002/ejp.929. PMID: 27558412. PMCID: PMC5245112.

25. Han T. Opioids in cancer and non-cancer pain management in Korea:the past, present and future. Eur J Pain. 2001; 5(Suppl A):73–8. DOI: 10.1053/eujp.2001.0284. PMID: 11798222.

26. Kim KY, Anoushiravani AA, Chen KK, Roof M, Long WJ, Schwarzkopf R. Preoperative chronic opioid users in total knee arthroplasty-which patients persistently abuse opiates following surgery? J Arthroplasty. 2018; 33:107–12. DOI: 10.1016/j.arth.2017.07.041. PMID: 28844770.

27. Armaghani SJ, Lee DS, Bible JE, Archer KR, Shau DN, Kay H, et al. Preoperative opioid use and its association with perioperative opioid demand and postoperative opioid independence in patients undergoing spine surgery. Spine (Phila Pa 1976). 2014; 39:E1524–30. DOI: 10.1097/BRS.0000000000000622. PMID: 25417827.