Department of Health Science and Technology, Center for Sensory Motor Interaction (SMI).
Department of Health Science and Technology, Center for Neuroplasticity and Pain, Faculty of Medicine.
Clin J Pain. 2020 Jan;36(1):34-40. doi: 10.1097/AJP.0000000000000768.
Synovitis is one of the possible pain generators in osteoarthritis (OA) and is associated with upregulation of proinflammatory cytokines, which can lead to worsening of the postoperative pain. This exploratory study aimed to investigate the association between perioperative synovitis and self-reported pain 12 months after total knee arthroplasty (TKA) in patients with OA.
Twenty-six knee OA patients were included in this analysis. The perioperative volume of synovitis in predefined locations was assessed by contrast-enhanced magnetic resonance imaging (CE-MRI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Perioperative synovitis was assessed histologically from biopsies of the synovium. Highest pain intensity within the last 24 hours (Visual Analog Scale, VAS, 0 to 100) was assessed before and 12 months after TKA. Patients were divided into a low-pain intensity (VAS≤30) and a high-pain intensity (VAS>30) group on the basis of 12 months postoperative VAS.
The high-pain intensity group had significantly lower perioperative contrast-enhanced-synovitis (P=0.025), DCE-synovitis (P<0.04), and a trend toward lower histologically assessed synovitis (P=0.077) compared with the low-pain intensity group. Perioperative synovitis scores were inversely correlated with pain intensity 12 months after TKA (P<0.05), indicating that more severe perioperative synovitis is associated with less severe pain intensity at 12 months.
Higher degrees of perioperative synovitis scores are found to be associated with less postoperative pain 12 months after TKA. Further, correlation analysis revealed that less severe perioperative CE-MRI and DCE-MRI synovitis was associated with higher pain intensity 12 months after TKA, suggesting that CE-MRI and DCE-MRI synovitis grades could be used as imaging markers for prediction of chronic postoperative pain after TKA.
滑膜炎是骨关节炎（OA）中一种可能的疼痛产生源，与促炎细胞因子的上调有关，这可能导致术后疼痛恶化。本探索性研究旨在调查 OA 患者全膝关节置换术（TKA）后 12 个月围手术期滑膜炎与自报告疼痛之间的关系。
本分析纳入了 26 例膝关节 OA 患者。通过对比增强磁共振成像（CE-MRI）和动态对比增强磁共振成像（DCE-MRI）评估预定部位的围手术期滑膜炎体积。通过滑膜活检评估围手术期滑膜炎的组织学表现。在 TKA 前后评估过去 24 小时内的最高疼痛强度（视觉模拟量表，VAS，0 到 100）。根据 12 个月时 VAS 将患者分为低疼痛强度（VAS≤30）和高疼痛强度（VAS>30）组。
高疼痛强度组的围手术期增强滑膜炎（P=0.025）、DCE 滑膜炎（P<0.04）和组织学评估的滑膜炎（P=0.077）明显低于低疼痛强度组。围手术期滑膜炎评分与 TKA 后 12 个月疼痛强度呈负相关（P<0.05），表明围手术期滑膜炎越严重，TKA 后 12 个月疼痛强度越低。
较高的围手术期滑膜炎评分与 TKA 后 12 个月的术后疼痛较轻有关。此外，相关性分析表明，围手术期 CE-MRI 和 DCE-MRI 滑膜炎较轻与 TKA 后 12 个月的疼痛强度较高相关，提示 CE-MRI 和 DCE-MRI 滑膜炎分级可作为预测 TKA 后慢性术后疼痛的影像学标志物。
