Chronic pain at 1-year following knee arthroplasty is associated with a worse joint-specific function and health-related quality of life

IF 5 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-09-26 DOI:10.1002/ksa.12455

Nick D. Clement, Samantha Jones, Irrum Afzal, Deiary F. Kader

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Abstract

Purpose

The purpose of this study was to identify independent variables associated with chronic pain (CP) at 1 year following knee arthroplasty (KA) and whether this influenced functional outcomes.

Methods

This retrospective study was conducted over a 2-year period and included 2588 patients with completed Oxford knee score (OKS) and EuroQol (EQ)-five domains (5D) preoperatively and at 1 and 2 years postoperatively. The OKS pain component score was used to define patients with CP (≤14 points). The mean age was 70.0 (range 34–94) years and there were 1553 (60.0%) females.

Results

There were 322 (12.4%) patients with CP at 1 year. A worse preoperative EQ-5D (p = 0.025), EQ-visual analogue scale (VAS) (p = 0.005) and OKS questions relating to washing (p = 0.010), limping (p = 0.007), kneeling (p = 0.003) and night pain (p = 0.004) were independently associated with risk of CP. However, the preoperative OKS (area under the curve [AUC]: 72.0, p < 0.001) and EQ-5D score (AUC: 70.1, p < 0.001) were the most reliable predictors, with threshold values of <18-points and <0.300 being predictive of CP, respectively. Of those with CP at 1 year, 231 were followed up at 2 years, of which 92 (39.8%) had resolution of their CP. A worse response to OKS question 11 (ability to shop) and EQ-5D (p = 0.028) at 1 year was independently associated with persistent CP. Patients with CP had significantly (p < 0.001) worse OKS, EQ-5D and EQ-VAS at 1 year compared to those without. However, for those that had resolution of their CP at 2 years, their outcomes were clinically equal to those that did not have CP at 1 year.

Conclusion

One in eight patients had CP at 1 year following surgery, which was associated with clinically worse knee-specific outcomes and quality of life. However, by 2 years, two in five patients had resolution of their CP and had functional outcomes clinically equal to those without CP at 1 year. The risk factors identified could be used to inform patients of their risk for CP and the potential for resolution.

Level of Evidence

Level III retrospective study.

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膝关节置换术后 1 年的慢性疼痛与关节功能和与健康相关的生活质量下降有关。

目的：本研究旨在确定膝关节置换术（KA）术后 1 年与慢性疼痛（CP）相关的独立变量，以及这些变量是否会影响功能预后：这项回顾性研究历时两年，共纳入了 2588 名患者，他们在术前以及术后 1 年和 2 年完成了牛津膝关节评分（OKS）和欧洲质量标准（EQ）--五个领域（5D）。牛津膝关节评分（OKS）的疼痛部分得分被用来定义CP患者（≤14分）。平均年龄为 70.0 岁（34-94 岁不等），女性 1553 人（60.0%）：1年后，有322名（12.4%）患者患有CP。术前 EQ-5D (p = 0.025)、EQ-视觉模拟量表 (VAS) (p = 0.005) 和 OKS 中有关清洗 (p = 0.010)、跛行 (p = 0.007)、下跪 (p = 0.003) 和夜间疼痛 (p = 0.004) 的问题均与 CP 风险独立相关。然而，术前 OKS（曲线下面积 [AUC]：72.0，p 结论：术前 OKS 与 CP 风险无关：每八名患者中就有一人在术后一年出现 CP，这与膝关节特异性临床预后和生活质量的恶化有关。然而，到了两年后，每五名患者中就有两名患者的膝关节囊肿得到了缓解，其临床功能结果与一年前无膝关节囊肿的患者相同。所发现的风险因素可用于告知患者CP的风险和缓解的可能性：证据等级：三级回顾性研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).