Sodhi Nipun, Qilleri Aleksandra, Aprigliano Caroline, Danoff Jonathan R
Department of Orthopaedics, Northwell Health, North Shore University Hospital, Long Island Jewish Medical Center, Manhasset, New York.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, New York.
J Arthroplasty. 2025 Apr;40(4):880-886. doi: 10.1016/j.arth.2024.09.028. Epub 2024 Sep 20.
Multimodal pain regimens are universally applied to all patients, despite known differences in pain and responses to medication between patients of different sexes, ethnicities, and races. The purpose of this study was to understand the influence of patient sex on postoperative total knee arthroplasty pain perception as well as the efficacy of perioperative pregabalin for pain control.
Visual analog Scales (VASs) and Knee Injury and Osteoarthritis Outcome Junior (KOOS Jr.) scores were prospectively collected for 150 patients (64 men and 86 women). Mean pain scores, delta pain scores, time to achieve minimal clinically important differences, influence of pregabalin, and opioid consumption were recorded at baseline, day of surgery, 24 hours, 48 hours, and 72 hours postoperatively, as well as postoperatively weeks 1, 2, 6, 12, and 26, and compared between women and men cohorts. This study was registered on ClinicalTrials.gov (NCT04471233).
The VAS pain scores for women were higher than for men at all study time points (P < 0.05). The change in VAS walking and mean KOOS Jr. scores from baseline to final follow-up at 26 weeks were not significantly different between cohorts. Both cohorts achieved VAS minimal clinically important difference by 2 weeks postoperatively. No significant differences in opioid consumption between men and women were noted during the study time periods. Women were also noted to have significantly higher raw KOOS Jr. scores than men at all-time points, except for at 26 weeks postoperatively. Interim analysis revealed no significant influence of pregabalin on VAS scores, so this arm of the study was discontinued.
Patient sex plays a role in perceived postoperative total knee arthroplasty pain, as women reported higher pain scores than men. We recommend not overly relying on standardized protocols, but rather instituting patient-specific pain management strategies.
尽管已知不同性别、种族和民族的患者在疼痛及对药物的反应方面存在差异，但多模式镇痛方案仍普遍应用于所有患者。本研究的目的是了解患者性别对全膝关节置换术后疼痛感知的影响以及围手术期使用普瑞巴林控制疼痛的疗效。
前瞻性收集了150例患者（64例男性和86例女性）的视觉模拟量表（VAS）评分和膝关节损伤与骨关节炎疗效评分青少年版（KOOS Jr.）。记录了基线、手术日、术后24小时、48小时、72小时以及术后第1、2、6、12和26周时的平均疼痛评分、疼痛差值评分、达到最小临床重要差异的时间、普瑞巴林的影响以及阿片类药物的消耗量，并在男性和女性队列之间进行比较。本研究已在ClinicalTrials.gov上注册（NCT04471233）。
在所有研究时间点，女性的VAS疼痛评分均高于男性（P<0.05）。两个队列从基线到术后26周最终随访时VAS行走评分和平均KOOS Jr.评分的变化无显著差异。两个队列均在术后2周达到VAS最小临床重要差异。在研究期间，未观察到男性和女性在阿片类药物消耗量方面的显著差异。还注意到，除术后26周外，女性在所有时间点的原始KOOS Jr.评分均显著高于男性。中期分析显示普瑞巴林对VAS评分无显著影响，因此本研究的该部分被终止。
患者性别在全膝关节置换术后的疼痛感知中起作用，因为女性报告的疼痛评分高于男性。我们建议不要过度依赖标准化方案，而应制定针对患者的疼痛管理策略。
