Retrospective analysis of the influencing factors of chronic pain after total knee arthroplasty

doi:10.12307/2022.963

Abstract

Abstract: BACKGROUND: The influencing factors of chronic pain after knee arthroplasty are a hot spot in clinical research. However, there are few reports on how to achieve individualized prediction of the risk of chronic pain after knee arthroplasty at home and abroad.
OBJECTIVE: To explore the influencing factors of chronic pain after knee arthroplasty by constructing and validating an individualized prediction model of chronic pain risk after knee arthroplasty using nomogram.
METHODS: Totally 212 patients who underwent knee arthroplasty in the First Affiliated Hospital of Shihezi University from January 2018 to October 2020 were enrolled in this study. The data of the patients were collected and followed up. Through Logistics regression analysis, the independent risk factors of chronic pain after knee arthroplasty were selected to construct a predictive model. The C-index, ROC curve, calibration chart and decision curve analysis were used to evaluate the identification, calibration and clinical usefulness of the predictive model. The bootstrap verification was used to evaluate internal verification.
RESULTS AND CONCLUSION: (1) Predictors contained in the prediction nomogram included sleep, hip-knee-ankle angle, preoperative pain visual analogue scale score, pain visual analogue scale score at discharge, and time of tourniquet. The constructed model had a good recognition ability. (2) The ROC curve showed that the model predicted the influencing factors of chronic pain after knee arthroplasty. The area under the curve was 0.833, and the C-index calculated by the R software was 0.837 (95% CI: 0.824-0.849). The high C-index value of 0.810 4 could still be reached in the interval verification, with good calibration and good ability to predict. (3) It is concluded that sleep, hip-knee-ankle angle, preoperative pain visual analogue scale score, pain visual analogue scale score at discharge, and time of tourniquet are independent risk factors for chronic pain after knee arthroplasty. A nomogram model is constructed to predict the influencing factors of chronic pain after knee arthroplasty. Good discrimination and accuracy can provide scientific guidance for individualized clinical prevention and treatment of chronic pain after knee arthroplasty.

Key words: chronic pain after knee arthroplasty, knee osteoarthritis, total knee arthroplasty, pain sensitization, postoperative acute pain

CLC Number:

Wan Guoli, Shi Chenhui, Wang Weishan, Li Ang, Shi Xunda, Cai Yi. Retrospective analysis of the influencing factors of chronic pain after total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(4): 558-564.

Figures/Tables 7

References

[1] AL-MUSAWI H, HASSABALLA M, MANARA J, et al. Does Partial Knee Replacement Allow Return to High-Demand Activities? Cureus. 2021; 13(10):e18439.
[2] EIBICH P, DAKIN HA, PRICE AJ, et al. Associations between preoperative Oxford hip and knee scores and costs and quality of life of patients undergoing primary total joint replacement in the NHS England: an observational study. BMJ Open. 2018;8(4):e019477.
[3] GUMMARAJU A, MAILLOT C, BARYEH K, et al. Oxford Knee Score and EQ-5d poorly predict patient’s satisfaction following mechanically aligned total knee replacement: A cross-sectional study. Orthop Traumatol Surg Res. 2021;107(3):102867.
[4] BESWICK AD, WYLDE V, GOOBERMAN-HILL R, et al. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012;2(1):e000435.
[5] GUNGOR S, FIELDS K, AIYER R, et al. Incidence and risk factors for development of persistent postsurgical pain following total knee arthroplasty: A retrospective cohort study. Medicine (Baltimore). 2019; 98(28):e16450.
[6] BLIKMAN T, RIENSTRA W, VAN RAAIJ TM, et al. Duloxetine in OsteoArthritis (DOA) study: study protocol of a pragmatic open-label randomised controlled trial assessing the effect of preoperative pain treatment on postoperative outcome after total hip or knee arthroplasty. BMJ Open. 2016;6(3):e010343.
[7] DAVIS AM, PERRUCCIO AV, IBRAHIM S, et al. The trajectory of recovery and the inter-relationships of symptoms, activity and participation in the first year following total hip and knee replacement. Osteoarthritis Cartilage. 2011;19(12):1413-1421.
[8] HALKET A, STRATFORD PW, KENNEDY DM, et al. Using hierarchical linear modeling to explore predictors of pain after total hip and knee arthroplasty as a consequence of osteoarthritis. J Arthroplasty. 2010;25(2):254-262.
[9] WYLDE V, BESWICK AD, DENNIS J, et al. Post-operative patient-related risk factors for chronic pain after total knee replacement: a systematic review. BMJ Open. 2017;7(11):e018105.
[10] LENGUERRAND E, WYLDE V, GOOBERMAN-HILL R, et al. Trajectories of Pain and Function after Primary Hip and Knee Arthroplasty: The ADAPT Cohort Study. PLoS One. 2016;11(2):e0149306.
[11] 陈旭娟,尹小兵,仇荣敏,等. 全膝关节置换术后慢性疼痛的非手术相关影响因素的研究进展[J].临床与病理杂志,2021,41(2):7.
[12] ASO K, IKEUCHI M, TAKAYA S, et al. Chronic postsurgical pain after total knee arthroplasty: A prospective cohort study in Japanese population. Mod Rheumatol. 2021;31(5):1038-1044.
[13] HINMAN AD, CHAN PH, PRENTICE HA, et al. The Association of Race/Ethnicity and Total Knee Arthroplasty Outcomes in a Universally Insured Population. J Arthroplasty. 2020;35(6):1474-1479.
[14] ALTMAN R, ASCH E, BLOCH D, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039-1049.
[15] WANG H, ZHANG L, LIU Z, et al. Predicting medication nonadherence risk in a Chinese inflammatory rheumatic disease population: development and assessment of a new predictive nomogram. Patient Prefer Adherence. 2018;12:1757-1765.
[16] RICE D, KLUGER M, MCNAIR P, et al. Persistent postoperative pain after total knee arthroplasty: a prospective cohort study of potential risk factors. Br J Anaesth. 2018;121(4):804-812.
[17] EASTHAM JA, KATTAN MW, SCARDINO PT. Nomograms as predictive models. Semin Urol Oncol. 2002;20(2):108-115.
[18] HUANG YQ, LIANG CH, HE L, et al. Development and Validation of a Radiomics Nomogram for Preoperative Prediction of Lymph Node Metastasis in Colorectal Cancer. J Clin Oncol. 2016;34(18):2157-2164.
[19] WEBER P, GOLLWITZER H. Kinematic alignment in total knee arthroplasty. Oper Orthop Traumatol. 2021;33(6):525-537.
[20] TURCOT K, ARMAND S, LUBBEKE A, et al. Does knee alignment influence gait in patients with severe knee osteoarthritis? Clin Biomech (Bristol, Avon). 2013;28(1):34-39.
[21] SINGH JA, LEWALLEN DG. Patient-level improvements in pain and activities of daily living after total knee arthroplasty. Rheumatology (Oxford). 2014;53(2):313-320.
[22] ALIPOURIAN A, FARHADIAN N, ZERESHKI E, et al. Improvement of sleep quality 6 months after total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2021;16(1):342.
[23] LUO ZY, LI LL, WANG D, et al. Preoperative sleep quality affects postoperative pain and function after total joint arthroplasty: a prospective cohort study. J Orthop Surg Res. 2019;14(1):378.
[24] CREMEANS-SMITH J K, MILLINGTON K, SLEDJESKI E, et al. Sleep disruptions mediate the relationship between early postoperative pain and later functioning following total knee replacement surgery. J Behav Med. 2006;29(2):215-222.
[25] PINTO PR, MCINTYRE T, FERRERO R, et al. Risk factors for moderate and severe persistent pain in patients undergoing total knee and hip arthroplasty: a prospective predictive study. PLoS One. 2013;8(9): e73917.
[26] NOISEUX NO, CALLAGHAN JJ, CLARK CR, et al. Preoperative predictors of pain following total knee arthroplasty. J Arthroplasty. 2014;29(7): 1383-1387.
[27] LIM HA, SONG EK, SEON JK, et al. Causes of Aseptic Persistent Pain after Total Knee Arthroplasty. Clin Orthop Surg. 2017;9(1):50-56.
[28] PETERSEN KK, SIMONSEN O, LAURSEN MB, et al. The Role of Preoperative Radiologic Severity, Sensory Testing, and Temporal Summation on Chronic Postoperative Pain Following Total Knee Arthroplasty. Clin J Pain. 2018;34(3):193-197.
[29] GROSU I, LAVAND’HOMME P, THIENPONT E. Pain after knee arthroplasty: an unresolved issue. Knee Surg Sports Traumatol Arthrosc. 2014;22(8):1744-1758.
[30] LAVAND’HOMME PM, GROSU I, FRANCE MN, et al. Pain trajectories identify patients at risk of persistent pain after knee arthroplasty: an observational study. Clin Orthop Relat Res. 2014;472(5):1409-1415.
[31] THOMAZEAU J, ROUQUETTE A, MARTINEZ V, et al. Predictive Factors of Chronic Post-Surgical Pain at 6 Months Following Knee Replacement: Influence of Postoperative Pain Trajectory and Genetics. Pain physician. 2016;19(5):E729-741.
[32] FLETCHER D, STAMER UM, POGATZKI-ZAHN E, et al. Chronic postsurgical pain in Europe: An observational study. Eur J Anaesthesiol. 2015;32(10):725-734.
[33] BUVANENDRAN A, DELLA VALLE CJ, KROIN JS, et al. Acute postoperative pain is an independent predictor of chronic postsurgical pain following total knee arthroplasty at 6 months: a prospective cohort study. Reg Anesth Pain Med. 2019;44(3):e100036.
[34] LATREMOLIERE A, WOOLF CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10(9):895-926.
[35] CAO Z, GUO J, LI Q, et al. Comparison of efficacy and safety of different tourniquet applications in total knee arthroplasty: a network meta-analysis of randomized controlled trials. Ann Med. 2021;53(1):1816-1826.
[36] EJAZ A, LAURSEN AC, KAPPEL A, et al. Faster recovery without the use of a tourniquet in total knee arthroplasty. Acta Orthop. 2014;85(4): 422-426.
[37] WANG K, NI S, LI Z, et al. The effects of tourniquet use in total knee arthroplasty: a randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017;25(9):2849-2857.
[38] CHAUDHRY EA, AZIZ A, FARAZ A, et al. Application of Tourniquet Does Not Influence Early Clinical Outcomes After Total Knee Arthroplasty. Cureus. 2021;13(1):e12435.
[39] PYATI S, COBERT J, JABRE JF, et al. Effects of Tourniquets in the Development of Pain States: a Novel Clinical Pilot Study and Review of Utilization of Tissue Oximetry to Measure Neural Ischemia. Curr Pain Headache Rep. 2020;24(6):25.
[40] RASMUSSEN LE, HOLM H A, KRISTENSEN P W, et al. Tourniquet time in total knee arthroplasty. Knee. 2018;25(2):306-313.