Koh Hae Seok, Kim Yoon-Chung, Park DoJoon, Kang Mu Hyun, Choi Youn-Ho
Department of Orthopedic Surgery, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea.
Orthop Surg. 2025 Mar;17(3):876-887. doi: 10.1111/os.14342. Epub 2025 Jan 25.
Central sensitization (CS) is associated with quality of life (QOL) after total knee arthroplasty (TKA). However, how CS changes after TKA and whether these changes have clinical relevance remain unclear. Therefore, this study was conducted to identify changes in CS after TKA and to assess the clinical significance of these changes.
This retrospective study was conducted on 92 patients between January 2021 and May 2023. CS severity was quantified using the Central Sensitization Inventory (CSI). One year after TKA, the patients were divided into groups based on whether CS severity improved by ≥ 1 level (improved group) or did not improve (non-improved group). The differences in preoperative and postoperative characteristics of patients in the two groups were analyzed. These characteristics included demographics, underlying diseases, physical examinations, and the Hospital for Special Surgery (HSS) knee score. QOL improvement was compared based on two different minimal clinically important changes (MIC) in the Short-Form Health Survey (SF-36). Continuous variables were compared using Student's t-test or the Mann-Whitney U-test. The chi-squared test was used to compare categorical variables.
The postoperative CS severity in patients was significantly lower compared to preoperative levels (p < 0.001). The improved group exhibited a lower HSS knee pain score (p < 0.001). Out of the eight SF-36 scales, five showed significantly greater improvement in the improved group compared to the non-improved group. The mean postoperative increases in scores for all eight SF-36 scales exceeded the MIC in the improved group, whereas half of the scales fell below the MIC in the non-improved group.
CS showed improvement after TKA, particularly in patients with more severe preoperative pain. This improvement appears to be correlated with the improvement in QOL after TKA.
中枢敏化（CS）与全膝关节置换术（TKA）后的生活质量（QOL）相关。然而，TKA后CS如何变化以及这些变化是否具有临床相关性仍不清楚。因此，本研究旨在确定TKA后CS的变化，并评估这些变化的临床意义。
本回顾性研究对2021年1月至2023年5月期间的92例患者进行。使用中枢敏化量表（CSI）对CS严重程度进行量化。TKA术后一年，根据CS严重程度是否改善≥1级将患者分为两组（改善组）或未改善组（未改善组）。分析两组患者术前和术后特征的差异。这些特征包括人口统计学、基础疾病、体格检查和特殊外科医院（HSS）膝关节评分。基于简短健康调查问卷（SF-36）中两种不同的最小临床重要变化（MIC）比较生活质量改善情况。连续变量使用学生t检验或曼-惠特尼U检验进行比较。卡方检验用于比较分类变量。
患者术后CS严重程度显著低于术前水平（p<0.001）。改善组的HSS膝关节疼痛评分较低（p<0.001）。在八个SF-36量表中，与未改善组相比，改善组有五个量表显示出显著更大的改善。改善组中所有八个SF-36量表的术后平均得分增加超过了MIC，而未改善组中有一半的量表低于MIC。
TKA后CS有所改善，尤其是术前疼痛较严重的患者。这种改善似乎与TKA后生活质量的改善相关。
