Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway.
PLoS One. 2023 Mar 24;18(3):e0283446. doi: 10.1371/journal.pone.0283446. eCollection 2023.
Systematically review and synthesize preoperative and intraoperative factors associated with pain after total knee arthroplasty (TKA) in patients with osteoarthritis.
Based on a peer-reviewed protocol, we searched Medline, Embase, CINAHL, Cochrane Library, and PEDro for prospective observational studies (January 2000 to February 2023) investigating factors associated with pain after TKA. The primary outcome was pain twelve months after TKA. Pain at three and six months were secondary outcomes. Multivariate random-effects meta-analyses were used to estimate mean correlation (95% CIs) between factors and pain. Sensitivity analysis was performed for each risk of bias domain and certainty of evidence was assessed.
Of 13,640 studies, 29 reports of 10,360 patients and 61 factors were analysed. The mean correlation between preoperative factors and more severe pain at twelve months was estimated to be 0.36 (95% CI, 0.24, 0.47; P < .000; moderate-certainty evidence) for more catastrophizing, 0.15 (95% CI; 0.08, 0.23; P < .001; moderate-certainty evidence) for more symptomatic joints, 0.13 (95% CI, 0.06, 0.19; P < .001; very low-certainty evidence) for more preoperative pain. Mean correlation between more severe radiographic osteoarthritis and less pain was -0.15 (95% CI; -0.23, -0.08; P < .001; low-certainty evidence). In sensitivity analysis, the estimated correlation coefficient for pain catastrophizing factor increased to 0.38 (95% CI 0.04, 0.64). At six and three months, more severe preoperative pain was associated with more pain. Better preoperative mental health was associated with less pain at six months.
More pain catastrophizing, more symptomatic joints and more pain preoperatively were correlated with more pain, while more severe osteoarthritis was correlated with less pain one year after TKA. More preoperative pain was correlated with more pain, and better mental health with less pain at six and three months. These findings should be further tested in predictive models to gain knowledge which may improve TKA outcomes.
系统回顾和综合与骨关节炎患者全膝关节置换术后（TKA）疼痛相关的术前和术中因素。
根据同行评审的方案，我们在 Medline、Embase、CINAHL、Cochrane 图书馆和 PEDro 中搜索了 2000 年 1 月至 2023 年 2 月期间调查 TKA 后疼痛相关因素的前瞻性观察研究。主要结果是 TKA 后 12 个月的疼痛。3 个月和 6 个月时的疼痛为次要结果。使用多变量随机效应荟萃分析来估计因素与疼痛之间的平均相关性（95%CI）。对每个偏倚风险领域进行敏感性分析，并评估证据的确定性。
在 13640 项研究中，有 29 项研究报告了 10360 名患者和 61 个因素。术前因素与 12 个月时更严重疼痛之间的平均相关性估计为 0.36（95%CI，0.24，0.47；P <.000；中等确定性证据），更严重的灾难性思维为 0.15（95%CI；0.08，0.23；P <.001；中等确定性证据），更明显的关节症状为 0.13（95%CI，0.06，0.19；P <.001；极低确定性证据），术前疼痛更多。更严重的放射学骨关节炎与疼痛减轻之间的平均相关性为-0.15（95%CI；-0.23，-0.08；P <.001；低确定性证据）。在敏感性分析中，疼痛灾难化因素的估计相关系数增加到 0.38（95%CI 0.04，0.64）。在 6 个月和 3 个月时，术前疼痛更严重与疼痛更严重相关。术前更好的心理健康与 6 个月时疼痛减轻相关。
更多的疼痛灾难化、更多的关节症状和更多的术前疼痛与疼痛相关，而更严重的骨关节炎与 TKA 后 1 年的疼痛减轻相关。更多的术前疼痛与更多的疼痛相关，更好的心理健康与 6 个月和 3 个月时的疼痛减少相关。这些发现应该在预测模型中进一步测试，以获得可能改善 TKA 结果的知识。
