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Is Pain and Dissatisfaction After TKA Related to Early-grade Preoperative Osteoarthritis?

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

There is growing evidence to suggest many patients experience pain and dissatisfaction after TKA. The relationship between preoperative osteoarthritis (OA) severity and postoperative pain and dissatisfaction after TKA has not been established.

Questions/Purposes

We explored the relationship between early-grade preoperative OA with pain and dissatisfaction after TKA by (1) determining the incidence of early-grade preoperative OA in painful TKAs with no other identifiable abnormality; and (2) comparing this incidence with the incidence of early-grade OA in three other cohorts of patients undergoing TKA.

Methods

We evaluated all (n = 49) painful TKAs in a 1-year period that had no evidence of loosening, instability, malalignment, infection, or extensor mechanism dysfunction and classified the degree of preoperative OA according to the scale of Kellgren and Lawrence. For comparison, we identified three other cohorts of TKAs from the same center and classified their preoperative grade of OA: Group B (n = 100) was a consecutive series of primary TKAs performed for OA during the same year; Group C (n = 80) were asymptomatic TKAs from 1 to 4 years postoperatively; and Group D (n = 80) were TKAs with some degree of pain at 1 to 4 years postoperatively.

Results

Patients in Group A had a higher incidence of early-grade OA is preoperatively (49%) compared with any of the comparison groups: Group B, 5%; Group C, 6%; and Group D, 10%.

Conclusions

A high percentage of patients referred for unexplained pain after TKA had early-grade osteoarthritis preoperatively. Patients undergoing TKA for less than Grade 3 or 4 OA should be informed that they may be at higher risk for persistent pain and dissatisfaction.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Angel Poucher for assistance with manuscript preparation.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT, USA

    Gregory G. Polkowski II MD

  2. Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St Louis, MO, 63110, USA

    Erin L. Ruh MS, Toby N. Barrack, Ryan M. Nunley MD & Robert L. Barrack MD

Authors
  1. Gregory G. Polkowski II MD
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  2. Erin L. Ruh MS
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  3. Toby N. Barrack
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  4. Ryan M. Nunley MD
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  5. Robert L. Barrack MD
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Corresponding author

Correspondence to Robert L. Barrack MD.

Additional information

One of the authors (RMN) certifies that he has or may receive payments or benefits, during the study period, an amount less than $10,000 from Smith & Nephew Orthopaedics (Memphis, TN, USA), Wright Medical Technology Inc (Arlington, TN, USA), Salient Surgical Technologies, Inc (Portsmouth, NH, USA), and CardioMEMS (Atlanta, GA, USA). One author (RLB) certifies that he has or may receive payments or benefits, during the study period, an amount in excess of $1,000,001, from Smith & Nephew, and Stryker (Mahwah, NJ, USA). The institution of one of the authors (RLB) receives research support from EOS Imaging (Paris, France), Medical Compression Systems, Inc (West Hills, CA, USA), Smith & Nephew Inc, the National Institutes of Health, and Stryker.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Washington University School of Medicine, St Louis, MO, USA.

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Polkowski, G.G., Ruh, E.L., Barrack, T.N. et al. Is Pain and Dissatisfaction After TKA Related to Early-grade Preoperative Osteoarthritis?. Clin Orthop Relat Res 471, 162–168 (2013). https://doi.org/10.1007/s11999-012-2465-6

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  • DOI: https://doi.org/10.1007/s11999-012-2465-6

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