Kim Man-Soo, Choi Keun-Young, In Yong
Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea.
Medicina (Kaunas). 2025 May 18;61(5):912. doi: 10.3390/medicina61050912.
: Central sensitization (CS) has been identified as a significant factor influencing persistent pain and dissatisfaction following total knee arthroplasty (TKA). However, its effect on unicompartmental knee arthroplasty (UKA) remains largely unexplored. Unlike TKA, UKA preserves most native knee structures, with less bone cut, leading to different postoperative pain mechanisms. Nevertheless, the revision rate for unexplained pain following UKA is higher than after TKA. This study investigates the influence of preoperative CS on pain and dissatisfaction after UKA. : This retrospective cohort study included 121 patients who underwent primary UKA for medial compartment osteoarthritis of the knee. Patients were screened for CS preoperatively using the Central Sensitization Inventory (CSI) and categorized into a CS group (CSI ≥ 40; n = 26) and a non-CS group (CSI < 40; n = 95). Clinical outcomes, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score (FJS), and patient satisfaction, were assessed at the 2-year postoperative follow-up visit. A multivariate regression analysis was used to determine the risk factors for postoperative dissatisfaction. : The CS group reported significantly worse postoperative WOMAC pain, function, and total scores than the non-CS group (all < 0.05). FJS was also significantly worse in the CS group than in the non-CS group (64.4 vs. 72.7, respectively, = 0.005). Patient satisfaction was significantly lower in the CS group than in the non-CS group (65.4% vs. 95.8%, respectively, < 0.001). The multivariate logistic regression analysis demonstrated that patients with a CSI score ≥ 40 had an 11.349-fold increased likelihood of dissatisfaction after UKA (95% CI: 2.315-55.626, = 0.003). : This study underscores the importance of recognizing CS as a critical determinant of postoperative pain and functional recovery following UKA. Patients with high CSI scores experience greater pain, increased joint awareness, and overall poorer satisfaction despite technically successful surgeries.
中枢敏化（CS）已被确定为影响全膝关节置换术（TKA）后持续性疼痛和患者满意度的一个重要因素。然而，其对单髁膝关节置换术（UKA）的影响在很大程度上仍未得到探索。与TKA不同，UKA保留了大部分膝关节的原生结构，截骨量较少，导致术后疼痛机制不同。尽管如此，UKA术后不明原因疼痛的翻修率高于TKA。本研究调查术前CS对UKA术后疼痛和患者满意度的影响。 这项回顾性队列研究纳入了121例行初次UKA治疗膝关节内侧间室骨关节炎的患者。术前使用中枢敏化量表（CSI）对患者进行CS筛查，并分为CS组（CSI≥40；n = 26）和非CS组（CSI < 40；n = 95）。在术后2年随访时评估临床结局，包括西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、遗忘关节评分（FJS）和患者满意度。采用多因素回归分析确定术后不满意的危险因素。 CS组术后WOMAC疼痛、功能和总分均显著低于非CS组（均P < 0.05）。CS组的FJS也显著低于非CS组（分别为64.4和72.7，P = 0.005）。CS组患者满意度显著低于非CS组（分别为65.4%和95.8%，P < 0.001）。多因素logistic回归分析表明，CSI评分≥40的患者UKA术后不满意的可能性增加11.349倍（95%CI：2.315 - 55.626，P = 0.003）。 本研究强调了认识到CS是UKA术后疼痛和功能恢复的关键决定因素的重要性。尽管手术技术成功，但CSI评分高的患者经历更严重的疼痛、关节意识增强和总体满意度更低。
