Centre Orthopédique Santy, 24 Av Paul Santy, 69008 Lyon, France.
Knee Surg Sports Traumatol Arthrosc. 2011 Sep;19(9):1411-7. doi: 10.1007/s00167-011-1549-2. Epub 2011 May 20.
Residual pain during activities of daily living and/or at rest is a major cause of a patient's dissatisfaction after total knee arthroplasty (TKA). The management of a painful TKA, which has no obvious clinical or radiological explanation, requires further investigation with more sensitive imaging modalities (CT scan and bone scan) and hematological tests. It is often challenging for the physician to determine what level of pain warrants these more complex and expensive medical examinations. A precise knowledge of the natural history of postoperative pain following TKA is therefore of fundamental importance.
We reviewed the literature and highlighted the studies that investigated the evolution of pain after uncomplicated TKAs and the impact of demographic and psychosocial variables on a postoperative painful TKA.
Factors that are associated with a more painful knee include female sex, a younger age at the time of surgery, and a higher than normal depressive or anxiety state. In particular, the Pain Catastrophizing Scale (PCS), a scale that quantifies a patient's negative or exaggerated orientation to pain, appears to significantly influence a patient's outcome after TKA.
The identification of these high-risk patients is critical so that a surgeon can provide detailed preoperative education in order to give these patients a realistic expectation of their possible satisfaction following TKA.
日常生活活动期间和/或休息时仍存在疼痛是全膝关节置换术后患者不满意的主要原因。对于无明显临床或影像学表现的疼痛 TKA，需要进一步采用更敏感的影像学（CT 扫描和骨扫描）和血液检查进行检查。医生常常难以确定何种程度的疼痛需要进行这些更复杂和昂贵的医学检查。因此，准确了解 TKA 后术后疼痛的自然病程至关重要。
我们复习了文献，并强调了研究术后单纯 TKA 疼痛演变以及人口统计学和心理社会变量对术后疼痛 TKA 的影响的研究。
与更疼痛的膝关节相关的因素包括女性、手术时年龄较小以及抑郁或焦虑状态高于正常水平。特别是疼痛灾难化量表（PCS），一种量化患者对疼痛的负面或夸大倾向的量表，似乎对 TKA 后患者的结局有显著影响。
识别这些高风险患者至关重要，以便外科医生可以提供详细的术前教育，使这些患者对 TKA 后可能的满意度有一个现实的预期。
