Early postoperative pain between the first and second staged bilateral total knee arthroplasty: a retrospective comparative analysis

doi:10.3969/j.issn.2095-4344.2014.31.005

Abstract

Abstract:

BACKGROUND: Total knee arthroplasty solves a great pain for patients with severe knee joint disease, and its clinical curative effects have been generally accepted. In the clinic, the formulation of clinical analgesic program of the two surgeries in patients undergoing double knee prosthesis lacks of the support of evidence-based medicine.
OBJECTIVE: To compare the differences in pain during early stage of primary and secondary surgeries in bilateral total knee arthroplasty, and to provide evidence for clinical analgesic programs.
METHODS: A total of 87 patients receiving staged bilateral total knee arthroplasty from January 2009 to January 2013 were retrospectively analyzed. Visual analogue scale was compared at 24, 48 and 72 hours after first and second staged total knee arthroplasty, including seating and maximum flexion position. In addition, the difference in early pain score was compared between second and first total knee arthroplasty in different intervals (less than 6 months, 6-12 months, more than 12 months).
RESULTS AND CONCLUSION: The visual analogue scale scores at seating and maximum flexion position at 24 and 48 hours after second total knee arthroplasty were significantly higher than the first surgery. No significant difference in visual analogue scale scores was detected between 72-hour seating and maximum flexion position. Visual analogue scale scores were significantly higher in the interval of less than 6 months than in the 6-12 month group and more than 12 month group in the 24-hour seating and maximum flexion position after second total knee arthroplasty. No significant difference in visual analogue scale scores was detected between the 6-12 month group and more than
12 month group at seating and maximum flexion position. Results suggested that the pain of second surgery was obviously higher than the first surgery within 48 hours after staged bilateral total knee arthroplasty, and this can provide a clinical evidence to enhance the analgesic strategy in the second staged bilateral total knee arthroplasty. The interval between two surgeries also affected the early pain after second surgery. Considered the aspect of postoperative pain, it is better to suggest the interval between first and second surgeries in staged total knee arthroplasty should be more than 6 months. This can reduce pain after second surgery, elevate patient’s satisfaction and accelerate the speed of recovery.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: arthroplasty, replacement, knee, pain, postoperative, pain measurement

CLC Number:

R318

Sun Jiu-yi, Zhou Yi-qin. Early postoperative pain between the first and second staged bilateral total knee arthroplasty: a retrospective comparative analysis[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(31): 4944-4949.

Figures/Tables 4

References

[1] Kim S, Meehan JP ,White R. Operative risk of staged bilateral knee arthroplasty is underestimated in retrospective studies. J Arthroplasty. 2011;26: 1198-1204.
[2] Leitch KK, Dalgorf D, Borkhoff CM, et al. Bilateral total knee arthroplasty--staged or simultaneous? Ontario's orthopedic surgeons reply. Can J Surg. 2005;48: 273-276.
[3] Ritter M, Mamlin LA, Melfi CA, et al. Outcome implications for the timing of bilateral total knee arthroplasties. Clin Orthop Relat Res. 1997;(345):99-105.
[4] Husted H, Troelsen A, Otte KS, et al. Fast-track surgery for bilateral total knee replacement. J Bone Joint Surg Br. 2011; 93: 351-356.
[5] Hu J, Liu Y, Lv Z, et al. Mortality and morbidity associated with simultaneous bilateral or staged bilateral total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg. 2011; 131(9):1291-1298.
[6] Patil N, Wakankar H. Morbidity and mortality of simultaneous bilateral total knee arthroplasty. Orthopedics. 2008:31: 780-789.
[7] Restrepo C, Parvizi J, Dietrich T, et al. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg. 2007;89: 1220-1226.
[8] Barrett J, Baron JA, Losina E, et al. Bilateral total knee replacement: staging and pulmonary embolism. The J Bone Joint Surg. 2006;88: 2146-2151.
[9] Oakes DA, Hanssen AD. Bilateral total knee replacement using the same anesthetic is not justified by assessment of the risks. Clin Orthop Relat Res. 2004;(428):87-91.
[10] Cohen RG, Forrest CJ, Benjamin JB. Safety and efficacy of bilateral total knee arthroplasty. J Arthroplasty. 1997;12: 497-502.
[11] Odum SM, Troyer JL, Kelly MP, et al. A cost-utility analysis comparing the cost-effectiveness of simultaneous and staged bilateral total knee arthroplasty. J Bone Joint Surg. 2013;95: 1441-1449.
[12] Leonard L, Williamson DM, Ivory JP , et al. An evaluation of the safety and efficacy of simultaneous bilateral total knee arthroplasty. JArthroplasty. 2003;18: 972-978 .
[13] Kim YH. Incidence of fat embolism syndrome after cemented or cementless bilateral simultaneous and unilateral total knee arthroplasty. J Arthroplasty. 2001;16: 730-739.
[14] Mangaleshkar SR, Prasad PS, Chugh S, et al. Staged bilateral total knee replacement--a safer approach in older patients. Knee. 2001;8, 207-211.
[15] Jankiewicz JJ, Sculco TP, Ranawat CS, et al. One-stage versus 2-stage bilateral total knee arthroplasty. Clin Orthop Relat Res. 1994;(309):94-101.
[16] Morrey BF, Adams RA, Ilstrup DM, et al. Complications and mortality associated with bilateral or unilateral total knee arthroplasty. J Bone Joint Surg. 1987;69: 484-488.
[17] Soudry M, Binazzi R, Insall JN, et al. Successive bilateral total knee replacement. J Bone Joint Surg. 1985:67: 573-576 .
[18] Cross WW 3rd, Saleh KJ, Wilt TJ, et al. Agreement about indications for total knee arthroplasty. Clin Orthop Relat Res. 2006;446:34-39.
[19] Carli F, Charlebois P, Stein B, et al. Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg. 2010;97: 1187-1197.
[20] Grosu I, Lavand'homme P, Thienpont E. Pain after knee arthroplasty: an unresolved issue. Knee Surg Sports Traumatol Arthrosc. 2013. [Epub ahead of print]
[21] 张飞,李奇,林荔军,等.联合多模式镇痛在全髋关节置换术后的早期疗效[J].中华关节外科,2013,7(3): 33-35.
[22] 龙成,孙俊英,刘跃洪,等.全膝关节置换术围手术期多模式镇痛的临床研究[J].中华关节外科, 2009,3(6):30-33.
[23] 符培亮,吴宇黎,吴海山,等.全膝置换术后关节内注射鸡尾酒式镇痛混合剂对镇痛效果的评价[J].中华骨科杂志,2008,28(7): 541-545.
[24] Qutob M, Winemaker M, Petruccelli D, et al. Staged bilateral total knee arthroplasty: does history dictate the future? J Arthroplasty. 2013;28:1148-1151.
[25] Jenny JY, Trojani C, Prudhon JL, et al. Simultaneous bilateral total knee arthroplasty. A multicenter feasibility study. Orthop Traumatol Surg Res. 2013;99: 191-195.
[26] Vulcano E, Memtsoudis S, Della Valle AG. Bilateral total knee arthroplasty guidelines: are we there yet? J Knee Surg. 2013; 26: 273-279.
[27] Memtsoudis SG, Mantilla CB, Parvizi J,et al. Have bilateral total knee arthroplasties become safer? A population-based trend analysis. Clin Orthop Relat Res. 2013;471: 17-25.
[28] Kim MH, Nahm FS, Kim TK,et al. Comparison of postoperative pain in the first and second knee in staged bilateral total knee arthroplasty: Clinical evidence of enhanced pain sensitivity after surgical injury. Pain. 2014; 155(1):22-27.
[29] Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain 2011;152: S2-15.
[30] Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science. 2000;288:1765-1769.
[31] Suzuki R, Dickenson A. Spinal and supraspinal contributions to central sensitization in peripheral neuropathy. Neurosignals. 2005;14: 175-181.
[32] Wieseler-Frank J, Maier SF, Watkins LR. Glial activation and pathological pain. Neurochem Int. 2004;45: 389-395.
[33] Suokas AK, Walsh DA, McWilliams DF, et al. Quantitative sensory testing in painful osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2012;20: 1075-1085.
[34] Arendt-Nielsen L, Nie H, Laursen MB, et al. Sensitization in patients with painful knee osteoarthritis. Pain. 2010;149: 573-581.
[35] Collett BJ. Opioid tolerance: the clinical perspective. Br J Anaesth. 1998;81: 58-68.
[36] Goldstein A , Sheehan P. Tolerance to opioid narcotics. I. Tolerance to the "running fit" caused by levorphanol in the mouse. J Pharmacol Exp Ther. 1969;169: 175-184.
[37] Yaksh TL. In vivo studies on spinal opiate receptor systems mediating antinociception. I. Mu and delta receptor profiles in the primate. J Pharmacol Exp Ther. 1983;226: 303-316.
[38] Wortzel HS, Frey KL, Anderson CA, et al. Subtle neurological signs predict the severity of subacute cognitive and functional impairments after traumatic brain injury. J Neuropsychiatry Clin Neurosci. 2009;21: 463-466.