Epworth Monash Rehabilitation Medicine Unit. Suite 2.4, 32 Erin Street, Richmond, VIC, 3121, Australia.
Whitlam Orthopaedic Research Centre, Orthopaedic Department, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Sydney, Australia.
BMC Musculoskelet Disord. 2022 Sep 12;23(1):855. doi: 10.1186/s12891-022-05800-0.
Moderate to severe levels of persistent knee pain have been estimated to affect up to 25% of people 3-months or more after a total knee replacement. It is unknown whether the type of rehabilitation pathway is associated with persistent high pain after surgery. Using a prospectively followed Australian cohort who underwent total knee replacement for knee osteoarthritis, this study aimed to i) report the incidence of high-intensity knee pain (defined as a score ≤ 15 on the Oxford Knee Score pain subscale) across time and ii) identify whether referral to inpatient rehabilitation was one of the predictors of persistent pain at 3-months post-surgery.
A retrospective analysis of a large prospective study was conducted using the Oxford Knee Score pain subscale to determine if participants had high pain at 3-months, 12-months and 36-months post-surgery. Relative risks for high pain at 3-, 12- and 36-months between the type of rehabilitation pathway were determined using Poisson multivariable regression with robust standard errors. The same technique was also employed to determine potential predictors, including rehabilitation pathway, of high pain at 3 months.
The incidence of high pain in all participants was 73% pre-surgery and 10, 5 and 6% at 3-, 12- and 36-months respectively following knee replacement. There was a significant interaction between time and rehabilitation pathway, suggesting that the effect of the rehabilitation pathway varied across time. The incidence of high pain at 3-months did not significantly differ between those who attended inpatient rehabilitation (11.6%) and those discharged directly home (9.5%). Multivariable Poisson regression analysis identified the pre-surgical presence of high pain, co-morbid low back pain or other lower limb problem, younger age and having a major complication within 3-months following surgery as significant predictors of persistent pain whilst discharge to inpatient rehabilitation was not.
A small but clinically significant minority of people continued to have high pain levels at 3-, 12- and 36-months following a primary total knee replacement for osteoarthritis. Participation in an inpatient rehabilitation program does not appear to be an important predictor of ongoing knee pain.
The data were collected in the Evidence-based Processes and Outcomes of Care (EPOC) study, ClinicalTrials.gov Identifier: NCT01899443.
据估计，在全膝关节置换术后 3 个月或更长时间，有 25%的患者会持续出现中重度膝关节疼痛。目前尚不清楚康复途径的类型是否与术后持续高疼痛有关。本研究使用前瞻性随访的澳大利亚队列，该队列因膝关节骨关节炎接受全膝关节置换术，旨在：i）报告随时间推移高强度膝关节疼痛（定义为牛津膝关节评分疼痛子量表得分≤15）的发生率；ii）确定术后 3 个月时是否转诊至住院康复是持续性疼痛的预测因素之一。
对一项大型前瞻性研究进行回顾性分析，使用牛津膝关节评分疼痛子量表确定参与者在术后 3 个月、12 个月和 36 个月时是否存在高疼痛。使用泊松多变量回归和稳健标准差确定不同康复途径之间 3 个月、12 个月和 36 个月时高疼痛的相对风险。同样的技术也用于确定潜在的预测因素，包括康复途径，以确定 3 个月时的高疼痛。
所有参与者术前的高疼痛发生率为 73%，术后分别为 10、5 和 6%，时间点分别为 3、12 和 36 个月。康复途径与时间之间存在显著的交互作用，这表明康复途径的效果随时间而变化。接受住院康复治疗（11.6%）和直接出院回家（9.5%）的患者在 3 个月时高疼痛的发生率无显著差异。多变量泊松回归分析确定术前存在高疼痛、合并腰痛或其他下肢问题、年龄较小以及术后 3 个月内发生重大并发症是持续性疼痛的显著预测因素，而出院至住院康复治疗不是。
一小部分但具有临床意义的人在因骨关节炎接受初次全膝关节置换术后 3、12 和 36 个月仍持续存在高疼痛水平。参与住院康复计划似乎不是持续性膝关节疼痛的重要预测因素。
数据来自于循证过程和护理结果（EPOC）研究，ClinicalTrials.gov 标识符：NCT01899443。
