Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
Pain. 2013 Sep;154(9):1588-1594. doi: 10.1016/j.pain.2013.04.033. Epub 2013 Apr 20.
Pain and sensitization are major issues in patients with osteoarthritis both before and after total knee arthroplasty (TKA) and revision TKA (re-TKA). The aim of this study was to assess sensitization in patients with and without chronic pain after re-TKAs. Twenty patients with chronic knee pain and 20 patients without pain after re-TKA participated. Spreading of pain was evaluated as the number of pain sites using a region-divided body chart. The pressure pain threshold (PPT) and pressure pain tolerance (PTT) were assessed by cuff algometry at the lower leg. Temporal summation of pain was assessed by recordings of the pain intensity on a visual analog scale (VAS) during repeated cuff pressure stimulations. Conditioning pain modulation (CPM) was recorded by experimental tonic arm pain by cuff pressure stimulation and assessment of PPTs on the knee, leg, and forearm using handheld pressure algometry. Participants with pain after re-TKA compared to participants without pain demonstrated: (1) significantly more pain sites (P=.004), (2) decreased cuff PPTs and PTTs at the lower leg (P<.001), (3) facilitated temporal summation (P<.001), and (4) impaired CPM (P<.001). Additionally, significant correlations between knee pain intensity and cuff PPTs, temporal summation, and CPM and between total duration of knee pain and temporal summation were found (P<.05). This study demonstrated widespread sensitization in patients with pain after re-TKA and highlighted the importance of ongoing nociceptive input for the chronification process. This has important implications for future revisions, and precautions should be taken if patients have widespread sensitization.
疼痛和敏化是全膝关节置换术（TKA）和翻修 TKA（re-TKA）前后骨关节炎患者的主要问题。本研究旨在评估 re-TKA 后有慢性疼痛和无疼痛患者的敏化情况。20 例慢性膝关节疼痛患者和 20 例 re-TKA 后无疼痛患者参与了这项研究。使用分区身体图表评估疼痛部位的扩散情况。使用袖口测压法评估小腿的压痛阈（PPT）和压痛耐量（PTT）。通过在视觉模拟量表（VAS）上记录疼痛强度的记录来评估疼痛的时间总和。通过袖带压力刺激引起的实验性持续臂痛记录条件疼痛调制（CPM），并使用手动压力测压法评估膝关节、腿部和前臂的 PPT。与无 re-TKA 后疼痛的患者相比， re-TKA 后有疼痛的患者表现出：（1）更多的疼痛部位（P=.004），（2）小腿处的袖口 PPT 和 PTT 降低（P<.001），（3）时间总和增强（P<.001），以及（4）CPM 受损（P<.001）。此外，还发现膝关节疼痛强度与袖口 PPT、时间总和和 CPM 之间以及膝关节疼痛总持续时间与时间总和之间存在显著相关性（P<.05）。这项研究表明，re-TKA 后有疼痛的患者存在广泛的敏化现象，并强调了持续的伤害性输入对慢性化过程的重要性。这对未来的翻修有重要影响，如果患者存在广泛的敏化，应采取预防措施。
