Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 6, pp 1698–1708 | Cite as

Higher physical activity and lower pain levels before surgery predict non-improvement of knee pain 1 year after TKA

  • Nikolai KornilovEmail author
  • Maren Falch Lindberg
  • Caryl Gay
  • Alexander Saraev
  • Taras Kuliaba
  • Leiv Arne Rosseland
  • Anners Lerdal
Knee

Abstract

Purpose

The purpose of this study was to describe patterns of pain during the first year following total knee arthroplasty (TKA) and evaluate pre- and postoperative factors associated with pain and patient satisfaction at 1 year. It was hypothesized that more severe preoperative pain would be associated with more residual pain and lower patient satisfaction 1 year after surgery.

Methods

A longitudinal cohort study was performed with repeated measures of pain (0–10 numeric rating scale) and evaluation of other self-reported symptoms (Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and Fatigue Severity Score), daily functioning (Lawton Instrumental Activities of Daily Living Scale), quality of life (EQ-5D-3L), knee function (KSS Knee and Function Score), perioperative and clinical characteristics (e.g. surgery duration, brand of implant, comorbidities), biochemical parameters (haemoglobin, C-reactive protein, creatinine), and patient satisfaction (20-item scale). Post-surgical improvement was defined as at least a two-point decrease in the patient’s rating of pain interference with walking from baseline to 1 year. Hundred patients (mean age 64 ± 8 years and 93% female) consecutively admitted for uncomplicated primary TKA participated, and 79 with complete data were included in this analysis.

Results

Pain generally decreased during the first postoperative year, from an average rating of 6 (SD = 3) to 1 (SD = 2). However, 18 of the 79 patients experienced no improvement in pain from baseline to 1 year. Factors associated with non-improvement of pain interference with walking after TKA included lower preoperative ratings of pain interference with walking (p < 0.001) and lower preoperative ratings of average pain (p = 0.004), active or very active levels of preoperative physical activity (p = 0.017), and higher ratings of worst pain on the first three postoperative days (p = 0.028). Pain at 1 year was the only predictor of lower patient satisfaction at 1 year.

Conclusions

Patients with low preoperative pain ratings or high preoperative levels of physical activity are at increased risk of non-improvement in knee pain after TKA. This finding should be taken into consideration when selecting appropriate candidates for TKA surgery. Orthopaedic surgeons should pay particular attention to patients reporting low pain interference with walking and consider other conservative or surgical treatment options before TKA. Effective strategies for detection and treatment of TKA patients with high pain ratings at early follow-up visits also need to be developed.

Level of evidence

Prognostic study, Level II.

Keywords

Pain Total knee arthroplasty Patient satisfaction Outcome 

Abbreviations

FSS

Fatigue Severity Scale

HADS

Hospital Anxiety and Depression Scale

IADL

Instrumental Activities of Daily Living Scale

KSS

American Knee Society Score (Knee Score and Function Score)

SD

Standard deviation

TKA

Total knee arthroplasty

Notes

Authors’ contribution

NK developed the original idea and contributed to study coordination, performing the surgery, data interpretation, and drafting the manuscript. MFL developed the original idea and was involved in design of the study, study coordination, and paper editing. CG generated ideas and performed statistical analysis, data interpretation, and paper editing. AS and TK generated ideas and helped in performing the surgery, data collection, and paper editing. LAR generated ideas and participated in design of the study, study coordination, data interpretation, and paper editing. AL developed the original idea and contributed to design of the study, statistical analysis, data interpretation, and paper editing. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare no competing interests regarding the publication of this paper.

Ethical approval

The study was approved by the Institutional Review Board for research at the N.N. Vreden Research Institute of Traumatology and Orthopedics in Saint Petersburg, Russia (approval #: N228032013).

Funding:

No funding was received for this study.

References

  1. 1.
    Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F (2002) Test–retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res 53:737–740CrossRefPubMedGoogle Scholar
  2. 2.
    Baker PN, Rushton S, Jameson SS, Reed M, Gregg P, Deehan DJ (2013) Patient satisfaction with total knee replacement cannot be predicted from pre-operative variables alone: a cohort study from the National Joint Registry for England and Wales. Bone Joint J 95-B:1359–1365CrossRefPubMedGoogle Scholar
  3. 3.
    Becker R, Doring C, Denecke A, Brosz M (2011) Expectation, satisfaction and clinical outcome of patients after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:1433–1441CrossRefPubMedGoogle Scholar
  4. 4.
    Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63CrossRefPubMedGoogle Scholar
  5. 5.
    Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK et al (2008) Assessment of pain. Br J Anaesth 101:17–24CrossRefPubMedGoogle Scholar
  6. 6.
    Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72CrossRefPubMedGoogle Scholar
  7. 7.
    Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213CrossRefPubMedGoogle Scholar
  8. 8.
    Choi YJ, Ra HJ (2016) Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res 28:1–15CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Clarke H (2016) Transitional pain medicine: novel pharmacological treatments for the management of moderate to severe postsurgical pain. Expert Rev Clin Pharmacol 9:345–349CrossRefPubMedGoogle Scholar
  10. 10.
    Cleeland CS (1985) Measurement and prevalence of pain in cancer. Semin Oncol Nurs 1:87–92CrossRefPubMedGoogle Scholar
  11. 11.
    Cohen J (1992) A power primer. Psychol Bull 112:155–159CrossRefPubMedGoogle Scholar
  12. 12.
    Desmeules F, Dionne CE, Belzile EL, Bourbonnais R, Fremont P (2012) The impacts of pre-surgery wait for total knee replacement on pain, function and health-related quality of life six months after surgery. J Eval Clin Pract 18:111–120CrossRefPubMedGoogle Scholar
  13. 13.
    Dowsey MM, Gunn J, Choong PF (2016) Selecting those to refer for joint replacement: who will likely benefit and who will not? Best Pract Res Clin Rheumatol 28:157–171CrossRefGoogle Scholar
  14. 14.
    Dowsey MM, Nikpour M, Dieppe P, Choong PF (2012) Associations between pre-operative radiographic changes and outcomes after total knee joint replacement for osteoarthritis. Osteoarthr Cartil 20:1095–1102CrossRefPubMedGoogle Scholar
  15. 15.
    Dowsey MM, Smith AJ, Choong PF (2015) Latent class growth analysis predicts long term pain and function trajectories in total knee arthroplasty: a study of 689 patients. Osteoarthr Cartil 23:2141–2149CrossRefPubMedGoogle Scholar
  16. 16.
    Dowsey MM, Spelman T, Choong PF (2016) Development of a prognostic nomogram for predicting the probability of nonresponse to total knee arthroplasty 1 year after surgery. J Arthroplasty 31:1654–1660CrossRefPubMedGoogle Scholar
  17. 17.
    Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM (2001) Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94:149–158CrossRefPubMedGoogle Scholar
  18. 18.
    Grosu I, Lavand’homme P, Thienpont E (2014) Pain after knee arthroplasty: an unresolved issue. Knee Surg Sports Traumatol Arthrosc 22:1744–1758CrossRefPubMedGoogle Scholar
  19. 19.
    Hamilton DF, Lane JV, Gaston P, Patton JT, Macdonald D, Simpson AH et al (2013) What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement. BMJ Open 3:e002525CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Hirschmann MT, Testa E, Amsler F, Friederich NF (2013) The unhappy total knee arthroplasty (TKA) patient: higher WOMAC and lower KSS in depressed patients prior and after TKA. Knee Surg Sports Traumatol Arthrosc 21:2405–2411CrossRefPubMedGoogle Scholar
  21. 21.
    Ho JC, Stitzlein RN, Green CJ, Stoner T, Froimson MI (2016) Return to sports activity following UKA and TKA. J Knee Surg 29:254–259PubMedGoogle Scholar
  22. 22.
    Holmen J, Midthjell K, Krüger O, Langhammer A, Holmen TL, Bratberg GH et al (2003) The Nord-Trondelag Health Study 1995–97 (HUNT 2): objectives, contents, methods and participation. Nor Epidemiol 13:19–32Google Scholar
  23. 23.
    Hovik LH, Winther SB, Foss OA, Gjeilo KH (2016) Preoperative pain catastrophizing and postoperative pain after total knee arthroplasty: a prospective cohort study with one year follow-up. BMC Musculoskelet Disord 17:214CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14Google Scholar
  25. 25.
    Kalyadina SA, Ionova TI, Ivanova MO, Uspenskaya OS, Kishtovich AV, Mendoza TR et al (2008) Russian Brief Pain Inventory: validation and application in cancer pain. J Pain Symptom Manag 35:95–102CrossRefGoogle Scholar
  26. 26.
    Kapstad H, Rokne B, Stavem K (2010) Psychometric properties of the Brief Pain Inventory among patients with osteoarthritis undergoing total hip replacement surgery. Health Qual Life Outcomes 8:148CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Katz J, Weinrib A, Fashler SR, Katznelzon R, Shah BR, Ladak SS et al (2015) The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain. J Pain Res 8:695–702CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Kim SJ, Bamne A, Song YD, Kang YG, Kim TK (2015) Patients still wish for key improvements after total knee arthroplasty. Knee Surg Relat Res 27:24–33CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Kornilov N, Lindberg MF, Gay C, Saraev A, Kuliaba T, Rosseland LA et al (2016) Factors related to postoperative pain trajectories following total knee arthroplasty: a longitudinal study of patients admitted to a Russian orthopaedic clinic. Pain Res Treat 2016:3710312PubMedPubMedCentralGoogle Scholar
  30. 30.
    Lamplot JD, Wagner ER, Manning DW (2014) Multimodal pain management in total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty 29:329–334CrossRefPubMedGoogle Scholar
  31. 31.
    Lavand’homme PM, Grosu I, France MN, Thienpont E (2014) Pain trajectories identify patients at risk of persistent pain after knee arthroplasty: an observational study. Clin Orthop Relat Res 472:1409–1415CrossRefPubMedGoogle Scholar
  32. 32.
    Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186CrossRefPubMedGoogle Scholar
  33. 33.
    Lerdal A, Wahl A, Rustoen T, Hanestad BR, Moum T (2005) Fatigue in the general population: a translation and test of the psychometric properties of the Norwegian version of the fatigue severity scale. Scand J Public Health 33:123–130CrossRefPubMedGoogle Scholar
  34. 34.
    Lewis GN, Rice DA, McNair PJ, Kluger M (2015) Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth 114:551–561CrossRefPubMedGoogle Scholar
  35. 35.
    Lindberg MF, Miaskowski C, Rustoen T, Rosseland LA, Cooper BA, Lerdal A (2016) Factors that can predict pain with walking, 12 months after total knee arthroplasty. Acta Orthop 87:600–606CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Matsuda S, Kawahara S, Okazaki K, Tashiro Y, Iwamoto Y (2013) Postoperative alignment and ROM affect patient satisfaction after TKA. Clin Orthop Relat Res 471:127–133CrossRefPubMedGoogle Scholar
  37. 37.
    Mayr HO, Reinhold M, Bernstein A, Suedkamp NP, Stoehr A (2015) Sports activity following total knee arthroplasty in patients older than 60 years. J Arthroplasty 30:46–49CrossRefPubMedGoogle Scholar
  38. 38.
    Mehta SP, Perruccio AV, Palaganas M, Davis AM (2015) Do women have poorer outcomes following total knee replacement? Osteoarthr Cartil 23:1476–1482CrossRefPubMedGoogle Scholar
  39. 39.
    Na SE, Ha CW, Lee CH (2012) A new high-flexion knee scoring system to eliminate the ceiling effect. Clin Orthop Relat Res 470:584–593CrossRefPubMedGoogle Scholar
  40. 40.
    Nilsdotter AK, Toksvig-Larsen S, Roos EM (2009) A 5 year prospective study of patient-relevant outcomes after total knee replacement. Osteoarthr Cartil 17:601–606CrossRefPubMedGoogle Scholar
  41. 41.
    Owens WD, Felts JA, Spitznagel EL Jr (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49:239–243CrossRefPubMedGoogle Scholar
  42. 42.
    Page MG, Katz J, Romero Escobar EM, Lutzky-Cohen N, Curtis K, Fuss S et al (2015) Distinguishing problematic from nonproblematic postsurgical pain: a pain trajectory analysis after total knee arthroplasty. Pain 156:460–468CrossRefPubMedGoogle Scholar
  43. 43.
    Parvizi J, Gehrke T, Chen AF (2013) Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 95-B:1450–1452CrossRefPubMedGoogle Scholar
  44. 44.
    Parvizi J, Nunley RM, Berend KR, Lombardi AV Jr, Ruh EL, Clohisy JC et al (2014) High level of residual symptoms in young patients after total knee arthroplasty. Clin Orthop Relat Res 472:133–137CrossRefPubMedGoogle Scholar
  45. 45.
    Puolakka PA, Rorarius MG, Roviola M, Puolakka TJ, Nordhausen K, Lindgren L (2010) Persistent pain following knee arthroplasty. Eur J Anaesthesiol 27:455–460CrossRefPubMedGoogle Scholar
  46. 46.
    Riddle DL, Perera RA, Jiranek WA, Dumenci L (2015) Using surgical appropriateness criteria to examine outcomes of total knee arthroplasty in a United States sample. Arthritis Care Res 67:349–357CrossRefGoogle Scholar
  47. 47.
    Scott CE, Howie CR, MacDonald D, Biant LC (2010) Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 92:1253–1258CrossRefPubMedGoogle Scholar
  48. 48.
    Si HB, Zeng Y, Shen B, Yang J, Zhou ZK, Kang PD et al (2015) The influence of body mass index on the outcomes of primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23:1824–1832CrossRefPubMedGoogle Scholar
  49. 49.
    Singh JA, Lewallen DG (2014) Patient-level improvements in pain and activities of daily living after total knee arthroplasty. Rheumatology (Oxford) 53:313–320CrossRefGoogle Scholar
  50. 50.
    Thorsen L, Nystad W, Stigum H, Dahl O, Klepp O, Bremnes RM et al (2005) The association between self-reported physical activity and prevalence of depression and anxiety disorder in long-term survivors of testicular cancer and men in a general population sample. Support Care Cancer 13:637–646CrossRefPubMedGoogle Scholar
  51. 51.
    Vaishya R, Vijay V, Demesugh DM, Agarwal AK (2016) Surgical approaches for total knee arthroplasty. J Clin Orthop Trauma 7:71–79CrossRefPubMedGoogle Scholar
  52. 52.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2007) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335:806–808CrossRefGoogle Scholar
  53. 53.
    W-Dahl A, Toksvig-Larsen S, Lindstrand A (2017) Ten-year results of physical activity after high tibial osteotomy in patients with knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 25:902–909CrossRefPubMedGoogle Scholar
  54. 54.
    Witjes S, Gouttebarge V, Kuijer PP, van Geenen RC, Poolman RW, Kerkhoffs GM (2016) Return to sports and physical activity after total and unicondylar knee arthroplasty: a systematic review and meta-analysis. Sports Med 46:269–292CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Wylde V, Dieppe P, Hewlett S, Learmonth ID (2007) Total knee replacement: is it really an effective procedure for all? Knee 14:417–423CrossRefPubMedGoogle Scholar
  56. 56.
    Wylde V, Sayers A, Lenguerrand E, Gooberman-Hill R, Pyke M, Beswick AD et al (2015) Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis. Pain 156:47–54CrossRefPubMedGoogle Scholar
  57. 57.
    Yakobov E, Scott W, Stanish W, Dunbar M, Richardson G, Sullivan M (2014) The role of perceived injustice in the prediction of pain and function after total knee arthroplasty. Pain 155:2040–2046CrossRefPubMedGoogle Scholar
  58. 58.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2017

Authors and Affiliations

  • Nikolai Kornilov
    • 1
    Email author
  • Maren Falch Lindberg
    • 2
    • 3
  • Caryl Gay
    • 4
    • 5
  • Alexander Saraev
    • 1
  • Taras Kuliaba
    • 6
  • Leiv Arne Rosseland
    • 7
    • 8
  • Anners Lerdal
    • 3
    • 5
  1. 1.Department of Knee Surgery N 17Russian Research Institute of Traumatology and Orthopaedics n.a. R.R. VredenSaint-PetersburgRussia
  2. 2.Department of SurgeryLovisenberg Diakonale HospitalOsloNorway
  3. 3.Department of Nursing Science, Institute of Health and Society, Faculty of MedicineUniversity of OsloOsloNorway
  4. 4.Department of Family Health Care NursingUniversity of CaliforniaSan FranciscoUSA
  5. 5.Department of Research and DevelopmentLovisenberg Diakonale HospitalOsloNorway
  6. 6.Department of Knee Surgery N 10Russian Research Institute of Traumatology and Orthopaedics n.a. R.R. VredenSaint-PetersburgRussia
  7. 7.Department of Research and Development, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
  8. 8.Institute of Clinical MedicineUniversity of OsloOsloNorway

Personalised recommendations