Department of Health Science and Technology, Center for Sensory-Motor Interaction (SMI).
Orthopaedic Research Unit, Aalborg University Hospital, Aalborg Denmark.
Clin J Pain. 2019 Jul;35(7):577-582. doi: 10.1097/AJP.0000000000000714.
Chronic postsurgical knee pain (CPSP) is a burden for ∼20% of the patients following total knee replacement (TKR). Presurgical pain intensities have consistently been found associated with CPSP, and it is suggested that comorbidities are likewise important for the development of CPSP. This study aimed to identify presurgical risk factors for the development of CPSP 5 years after TKR on the basis of medical records containing information with regard to comorbidities.
Patients undergoing primary TKR surgery were contacted 5 years after TKR. Presurgical Knee Society Score and comorbidities were evaluated. Postsurgical knee pain at 5 years of follow-up was assessed on a Numeric Rating Scale (NRS, 0 to 10). Logistic regression models were utilized to identify patients with moderate-to-severe (NRS≥3) and mild-to-no (NRS<3) CPSP at 5-year follow-up. Odds ratio (OR) for significant factors was calculated.
A total of 604 patients were contacted, 493 patients responded, 352 patients provided a completed questionnaire. A total of 107 patients reported NRS≥3 at follow-up. Significant presurgical factors associated with CPSP were fibromyalgia (OR=20.66; P=0.024), chronic pain in body parts other than the knee (OR=6.70; P=0.033), previous diagnosis of cancer (OR=3.06; P=0.001), knee instability (OR=2.16; P=0.021), younger age (OR=2.15; P=0.007), and presurgical knee pain (OR=1.61; P=0.044). Regression analysis identified 36 of 107 (33.6%) patients with CPSP on the basis of presurgical factors, and 231 patients (94.3%) without CPSP were classified correctly.
The current study found that a variety of presurgical clinical factors can correctly classify 33.6% of patients at risk for developing CPSP 5 years following TKR.
慢性术后膝关节疼痛（CPSP）是全膝关节置换术（TKR）后约 20%患者的负担。术前疼痛强度一直与 CPSP 相关，并且认为合并症对 CPSP 的发展同样重要。本研究旨在根据包含合并症信息的病历，确定 TKR 后 5 年 CPSP 发生的术前危险因素。
联系 TKR 手术后 5 年的原发性 TKR 手术患者。评估术前膝关节协会评分和合并症。在 5 年随访时，使用数字评分量表（NRS，0 到 10）评估术后膝关节疼痛。利用逻辑回归模型确定 5 年随访时中度至重度（NRS≥3）和轻度至无（NRS<3）CPSP 的患者。计算显著因素的优势比（OR）。
共联系了 604 名患者，493 名患者回复，352 名患者提供了完整的问卷。共有 107 名患者在随访时报告 NRS≥3。与 CPSP 相关的显著术前因素包括纤维肌痛（OR=20.66；P=0.024）、膝关节以外部位的慢性疼痛（OR=6.70；P=0.033）、既往癌症诊断（OR=3.06；P=0.001）、膝关节不稳定（OR=2.16；P=0.021）、年龄较小（OR=2.15；P=0.007）和术前膝关节疼痛（OR=1.61；P=0.044）。回归分析根据术前因素确定了 107 名 CPSP 患者中的 36 名（33.6%），正确分类了 231 名（94.3%）无 CPSP 的患者。
本研究发现，多种术前临床因素可以正确分类 33.6%的 TKR 后 5 年发生 CPSP 的风险患者。
