Sugimura Natsuki, Aso Koji, Wada Hiroyuki, Izumi Masashi, Ikeuchi Masahiko
Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan.
Department of Orthopedic Surgery, Hata Prefectural Hospital, Sukumo, Kochi, 788-0785, Japan.
J Pain Res. 2023 Aug 29;16:2981-2992. doi: 10.2147/JPR.S403641. eCollection 2023.
Some patients experience chronic postsurgical pain (CPSP) after total knee arthroplasty (TKA) despite the absence of clinical or radiographic abnormalities. Postoperative synovitis as a cause of CPSP after TKA has received limited research attention. This study aimed to investigate the relationship between synovitis after TKA and CPSP.
A total of 111 knees of 85 patients, with at least 1-year post-TKA follow-up, were assessed retrospectively and cross-sectionally. Power Doppler (PD) ultrasonography was used to detect the synovial hypervascularity associated with synovitis. The knee joint was divided into 15 areas, and PD signals were graded semi-quantitatively (0-3) in each area, the sum of which was defined as the total PD score. Clinical information regarding CPSP, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscales, was recorded. The relationship between pain and PD ultrasonography findings was accessed. Patients were divided into two groups (CPSP+ and CPSP- groups) based on pain severity. Clinical information, including PD ultrasonography findings and other possible causes, was compared between the groups.
The WOMAC pain subscale was significantly correlated with the total PD score and maximum PD grade (r=0.3977, p<0.0001; r=0.2797, p=0.0029; respectively). The CPSP+ group had a significantly higher maximum PD grade and total PD score than the CPSP- group (median [interquartile range]: 2 [1, 2] vs 1 [1, 2], p=0.0001; 6 [2, 11] vs 2 [1, 4], p=0.0002; respectively). Multiple and logistic regression analyses showed that the total PD score was an independent factor for the WOMAC pain subscale (β=0.3822, 95% confidence interval [CI]=0.1460, 0.6184, p=0.00176) and CPSP (odds ratio=1.19, 95% CI=1.01, 1.41, p=0.0424).
This study indicated a possible association between the total PD score and chronic pain after TKA; however, further studies are needed to corroborate these findings.
尽管没有临床或影像学异常，但一些患者在全膝关节置换术（TKA）后仍会经历慢性术后疼痛（CPSP）。TKA术后滑膜炎作为CPSP的一个病因，受到的研究关注有限。本研究旨在探讨TKA术后滑膜炎与CPSP之间的关系。
对85例患者的111个膝关节进行回顾性和横断面评估，这些患者TKA术后至少随访1年。使用能量多普勒（PD）超声检测与滑膜炎相关的滑膜血管增多。膝关节被分为15个区域，每个区域的PD信号进行半定量分级（0 - 3级），其总和定义为总PD评分。记录有关CPSP的临床信息，包括西安大略和麦克马斯特大学骨关节炎指数（WOMAC）疼痛亚量表。分析疼痛与PD超声检查结果之间的关系。根据疼痛严重程度将患者分为两组（CPSP +组和CPSP -组）。比较两组之间的临床信息，包括PD超声检查结果和其他可能的病因。
WOMAC疼痛亚量表与总PD评分和最大PD分级显著相关（分别为r = 0.3977，p < 0.0001；r = 0.2797，p = 0.0029）。CPSP +组的最大PD分级和总PD评分显著高于CPSP -组（中位数[四分位间距]：2[1, 2]对1[1, 2]，p = 0.（此处原文有误，应为0.0001）；6[2, 11]对2[1, 4]，p = 0.0002）。多元和逻辑回归分析表明，总PD评分是WOMAC疼痛亚量表（β = 0.3822，95%置信区间[CI] = 0.1460，0.6184，p = 0.00176）和CPSP（比值比 = 1.19，95%CI = 1.01，1.41，p = 0.0424）的独立因素。
本研究表明总PD评分与TKA术后慢性疼痛之间可能存在关联；然而，需要进一步研究来证实这些发现。
