University of Nottingham, Academic Orthopaedics, Trauma and Sports Medicine, Nottingham, UK.
Nottingham Elective Orthopaedic Service (NEOS), Nottingham University Hospitals NHS Trust, Nottingham, UK.
Eur J Pain. 2022 Oct;26(9):1979-1989. doi: 10.1002/ejp.2018. Epub 2022 Aug 19.
BACKGROUND: A subset of osteoarthritis patients will experience chronic postoperative pain after total knee arthroplasty (TKA), but the source of pain is unclear. The aim of this exploratory study was to assess patients with and without postoperative pain after TKA using magnetic resonance imaging (MRI), quantitative sensory testing (QST), clinical assessment of pain and assessments of catastrophizing thoughts. METHODS: Forty-six patients completed the 6-month postoperative assessment. MRI findings were scored according to the MRI Osteoarthritis Knee Score recommendation for Hoffa synovitis, effusion size and bone marrow lesions. QST included assessment of pressure pain thresholds (PPTs), temporal summation of pain (TSP) and conditioned pain modulation (CPM). Pain catastrophizing was assessed using the Pain Catastrophizing Scale (PCS). Clinical pain assessment was conducted using a visual analogue scale (VAS, 0-10 cm), and groups of moderate-to-severe (VAS > 3) and none-to-mild postoperative pain (VAS ≤ 3) were identified. RESULTS: Patients with moderate-to-severe postoperative pain (N = 15) demonstrated higher grades of Hoffa synovitis (p < 0.001) and effusion size (p < 0.001), lower PPTs (p = 0.039), higher TSP (p = 0.001) and lower CPM (p = 0.014) when compared with patients with none-to-mild postoperative pain (N = 31). No significant difference was found in PCS scores between the two groups. Multiple linear regression models found synovitis (p = 0.036), effusion size (p = 0.003), TSP (p = 0.013) and PCS (p < 0.001) as independent parameters contributing to the postoperative pain intensity. CONCLUSION: These exploratory findings could indicate that chronic postoperative pain after TKA is a combination of joint-related synovitis and effusion, sensitization of central pain mechanisms and potentially pain catastrophizing thoughts, but larger studies are needed to confirm this. SIGNIFICANCE: The end-stage treatment of knee osteoarthritis is total knee arthroplasty. Some patients experience chronic postoperative pain after total knee arthroplasty, but the mechanism for chronic postoperative pain is widely unknown. The current study indicates that higher levels postoperative of synovitis and effusion, higher temporal summation of pain and higher pain catastrophizing scores could be associated with higher chronic postoperative pain.
背景：全膝关节置换术（TKA）后，一部分骨关节炎患者会经历慢性术后疼痛，但疼痛的来源尚不清楚。本探索性研究旨在使用磁共振成像（MRI）、定量感觉测试（QST）、疼痛的临床评估以及对灾难化思维的评估来评估 TKA 后有和无术后疼痛的患者。
方法：46 名患者完成了术后 6 个月的评估。根据 MRI 骨关节炎膝关节评分推荐对 Hoffa 滑膜炎、积液大小和骨髓病变进行 MRI 发现评分。QST 包括评估压力疼痛阈值（PPT）、疼痛的时间总和（TSP）和条件疼痛调制（CPM）。使用疼痛灾难化量表（PCS）评估疼痛灾难化。使用视觉模拟量表（VAS，0-10cm）进行临床疼痛评估，并确定中度至重度（VAS＞3）和无至轻度术后疼痛（VAS≤3）的组。
结果：中重度术后疼痛患者（N=15）与无至轻度术后疼痛患者（N=31）相比，Hoffa 滑膜炎程度较高（p＜0.001），积液量较大（p＜0.001），PPT 较低（p=0.039），TSP 较高（p=0.001），CPM 较低（p=0.014）。两组间 PCS 评分无显著差异。多元线性回归模型发现滑膜炎（p=0.036）、积液量（p=0.003）、TSP（p=0.013）和 PCS（p＜0.001）是术后疼痛强度的独立参数。
结论：这些探索性发现可能表明，TKA 后慢性术后疼痛是关节相关滑膜炎和积液、中枢疼痛机制敏化以及潜在的疼痛灾难化思维的综合表现，但需要更大的研究来证实这一点。
意义：膝关节骨关节炎的终末期治疗是全膝关节置换术。一些患者在全膝关节置换术后会经历慢性术后疼痛，但慢性术后疼痛的机制尚不清楚。本研究表明，较高水平的术后滑膜炎和积液、较高的疼痛时间总和和较高的疼痛灾难化评分可能与较高的慢性术后疼痛相关。
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