Zhang Siqing, Tan Li, Bai Xuemei, Deng Linmei, Wan Sha, Ding Meng, Lin Kefu, Tian Zhen, Li Lang
Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China.
Department of Orthopedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital.C.T.), Chengdu, China.
Int Orthop. 2025 Jun 7. doi: 10.1007/s00264-025-06560-x.
Central sensitization (CS) plays a critical role in prolonged pain and poor outcomes after total knee arthroplasty (TKA), but its prevalence and impact in high-altitude populations remain unexplored. This study aims to examine the prevalence of CS, its associated factors, and short-term postoperative outcomes in high-altitude TKA patients.
This prospective, single-centre cohort study included high-altitude (above 2,500 m) TKA patients with primary knee osteoarthritis (OA). Central sensitization (CS) was diagnosed using the Central Sensitization Inventory (CSI), with a cutoff score of ≥ 40. Propensity score matching (PSM) was applied to balance baseline characteristics between the CS and non-CS groups. Preoperative factors, postoperative outcomes (pain levels, complications, opioid consumption, hospital stay), and the incidence of chronic pain and dissatisfaction at six months were collected and analyzed using SPSS software.
A total of 230 patients were included, with 36 (15.7%) classified as having CS. Multivariable logistic regression identified female gender (OR: 3.9, 95% CI: 1.0-14.3, P = 0.043), higher body mass index (BMI) (OR: 1.2, 95% CI: 1.1-1.3, P = 0.006), and residence above 4,000 m (OR: 5.1, 95% CI: 1.7-15.1, P = 0.003) as significant factors associated with CS. After PSM, the CS group had significantly worse short-term outcomes, with higher pain scores at 24, 48, and 72 h (P < 0.001), increased incidence of postoperative nausea and vomiting (PONV) (P < 0.001), longer hospital stays (P < 0.001), greater cumulative opioid consumption (P < 0.001), higher rates of chronic postoperative pain (46.9% vs. 21.9%, P = 0.014), and greater patient dissatisfaction (25.0% vs. 6.3%, P = 0.039) compared to the non-CS group.
This study found a 15.7% prevalence of CS among high-altitude TKA patients. Female gender, higher BMI, and residence at altitudes above 4,000 m were identified as factors associated with CS. Furthermore, CS was linked to worse short-term postoperative outcomes, including higher pain levels, increased incidence of PONV, greater opioid consumption, longer hospital stays, and a higher prevalence of chronic postoperative pain and dissatisfaction.
中枢敏化（CS）在全膝关节置换术（TKA）后疼痛持续和预后不良中起关键作用，但其在高原人群中的患病率及影响仍未得到探索。本研究旨在调查高原TKA患者中CS的患病率、相关因素及术后短期预后。
这项前瞻性、单中心队列研究纳入了患有原发性膝关节骨关节炎（OA）的高原（海拔2500米以上）TKA患者。使用中枢敏化量表（CSI）诊断中枢敏化（CS），临界值分数≥40。应用倾向评分匹配（PSM）来平衡CS组和非CS组之间的基线特征。收集术前因素、术后结局（疼痛程度、并发症、阿片类药物消耗量、住院时间）以及六个月时慢性疼痛和不满意的发生率，并使用SPSS软件进行分析。
共纳入230例患者，其中36例（15.7%）被归类为患有CS。多变量逻辑回归确定女性性别（比值比：3.9，95%置信区间：1.0 - 14.3，P = 0.043）、较高的体重指数（BMI）（比值比：1.2，95%置信区间：1.1 - 1.3，P = 0.0
