Mekkawy Kevin L, Zhang Bo, Wenzel Alyssa, Harris Andrew B, Khanuja Harpal S, Sterling Robert S, Hegde Vishal, Oni Julius K
Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA.
Arthroplasty. 2023 Aug 3;5(1):37. doi: 10.1186/s42836-023-00194-3.
Early postoperative pain following total knee arthroplasty significantly impacts outcomes and patient satisfaction. However, the characteristics and sources of early pain after total knee arthroplasty remain unclear. Therefore, the purpose of this study was to determine the anatomic distribution and course of postoperative pain in the acute and subacute period following total knee arthroplasty.
A prospective observational study of primary, elective unilateral total knee arthroplasty cases was conducted at our academic tertiary care medical center from January 2021 to September 2021. Preoperative variables were extracted from institutional electronic medical records. Postoperatively, patients utilized a knee pain map to identify the two locations with the most significant pain and rated it using the visual analog scale (VAS). The data were collected on day 0, at 2 weeks, 2 months, and 6 months after operation.
This study included 112 patients, with 6% of patients having no pain at postoperative day 0, 22% at 2 weeks, 46% at 2 months, and 86% at 6 months after operation. In those who reported pain, the VAS score (mean ± standard deviation) was 5.8 ± 2.4 on postoperative day 0 and decreased at each follow-up time point (5.4 ± 2.3 at 2 weeks, 3.9 ± 2.2 at 2 months, and 3.8 ± 2.7 at 6 months). The majority of patients were able to identify distinct loci of pain. The most common early pain loci were patellae, thigh, and medial joint line, and this distribution dissipated by 6 months.
At 2 postoperative weeks, pain was primarily at the medial joint, and at 6 months postoperatively, pain was more likely to be at the lateral joint. No relationship was found between pain at six months and pain scores or location at postoperative day 0 or 2 weeks. Understanding the distribution and progression of knee pain following total knee arthroplasty may benefit patient education and targeted interventions.
Level II, prospective observational study.
全膝关节置换术后早期疼痛对手术效果和患者满意度有显著影响。然而，全膝关节置换术后早期疼痛的特征和来源仍不明确。因此，本研究的目的是确定全膝关节置换术后急性期和亚急性期疼痛的解剖分布及发展过程。
2021年1月至2021年9月，在我们的学术三级医疗中心对原发性择期单侧全膝关节置换病例进行了一项前瞻性观察研究。术前变量从机构电子病历中提取。术后，患者使用膝关节疼痛地图来确定疼痛最明显的两个部位，并使用视觉模拟量表（VAS）进行评分。数据在术后第0天、2周、2个月和6个月收集。
本研究纳入了112例患者，术后第0天6%的患者无疼痛，2周时为22%，2个月时为46%，6个月时为86%。在报告疼痛的患者中，术后第0天VAS评分（均值±标准差）为5.8±2.4，在每个随访时间点均下降（2周时为5.4±2.3，2个月时为3.9±2.2，6个月时为3.8±2.7）。大多数患者能够识别出不同的疼痛部位。最常见的早期疼痛部位是髌骨、大腿和内侧关节线，这种分布在6个月时消失。
术后2周时，疼痛主要位于内侧关节，术后6个月时，疼痛更可能位于外侧关节。6个月时的疼痛与术后第0天或2周时的疼痛评分或部位之间未发现相关性。了解全膝关节置换术后膝关节疼痛的分布和发展过程可能有助于患者教育和针对性干预。
二级，前瞻性观察研究。
