Persistent pain and joint stiffness after surgery may interfere with recovery and adversely affect quality of life in up to 40% of patients who have undergone total knee arthroplasty. There is growing evidence that inflammation as well as other medical and psychological factors may be associated with osteoarthritis severity, progression, and associated pain severity. This study aims to identify clinical, biological, and psychological factors that contribute to and predict the development of these complications. Identification of such factors may allow us to target preventative measures to the patients at highest risk of persistent postoperative pain and joint stiffness.
Study Type
OBSERVATIONAL
Enrollment
179
Patients will undergo total unilateral knee arthroplasty for osteoarthritis.
Hospital for Special Surgery
New York, New York, United States
Presence of Persistent Postoperative Pain Using the Numeric Rating Scale (NRS)
Defined as numeric rating scale (NRS) pain score ≥4 with activity in the operated joint. A lower score is a better outcome. 0 is no pain, and 10 is worst pain imaginable.
Time frame: 6 months after date of surgery
Patients Who Experienced Postoperative Joint Stiffness
The number of patients that experienced postoperative joint stiffness, defined as ≤95 degrees range of motion.
Time frame: 6 weeks after date of surgery
Postoperative Knee Range of Motion
Range of motion at 6 weeks postoperative. Measured as flexion minus extension. Measured in degrees.
Time frame: 6 weeks after date of surgery
NRS Pain at Rest on POD1
NRS pain at rest on postoperative day 1, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable.
Time frame: 1 day after surgery
NRS Pain With Movement on POD1
NRS pain with movement on postoperative day 1, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable.
Time frame: 1 day after surgery
Worst NRS Pain on POD1
Worst NRS pain on postoperative day 1, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable.
Time frame: 1 day after surgery
Least NRS Pain on POD1
Least numerical rating scale (NRS) pain on postoperative day 1, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable.
Time frame: 1 day after surgery
NRS Pain at Rest on POD2
Numerical rating scale (NRS) pain at rest on postoperative day 2, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable.
Time frame: 2 days after surgery
NRS Pain With Movement on POD2
Numerical rating scale (NRS) pain with movement on postoperative day 2, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable.
Time frame: 2 days after surgery
Worst NRS Pain on POD2
Worst numerical rating scale (NRS) pain on postoperative day 2, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable.
Time frame: 2 days after surgery
Least NRS Pain on POD2
Least numerical rating scale (NRS) pain on postoperative day 2, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable.
Time frame: 2 days after surgery
NRS Pain at Rest 4 Weeks After Surgery
Numerical rating scale (NRS) pain at rest on 4 weeks postoperative, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable.
Time frame: 4 weeks after surgery
NRS Pain With Movement 4 Weeks After Surgery
Numerical rating scale (NRS) pain with movement on 4 weeks postoperative, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable.
Time frame: 4 weeks after surgery
Worst NRS Pain 4 Weeks After Surgery
Worst numerical rating scale (NRS) pain 4 weeks postoperative, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable.
Time frame: 4 weeks after surgery
Least NRS Pain 4 Weeks After Surgery
Least numerical rating scale (NRS) pain 4 weeks postoperative, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable.
Time frame: 4 weeks after surgery
NRS Pain at Rest 3 Months After Surgery
Numerical rating scale (NRS) pain at rest 3 months postoperative, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable.
Time frame: 3 months after surgery
NRS Pain With Movement 3 Months After Surgery
Numerical rating scale (NRS) pain with movement 3 months postoperative, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable. The average NRS pain for all participants who completed the survey at 3 months is reported.
Time frame: 3 months after surgery
Worst NRS Pain 3 Months After Surgery
Worst numerical rating scale (NRS) pain 3 months postoperative, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable. The average worst NRS pain for all participants who completed the survey at 3 months is reported.
Time frame: 3 months after date of surgery
Least NRS Pain 3 Months After Surgery
Least numerical pain rating (NRS) pain 3 months postoperative, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable. The average least NRS pain for all participants who completed the survey at 3 months is reported.
Time frame: 3 months after date of surgery
NRS Pain at Rest 6 Months After Surgery
NRS pain at rest 6 months postoperative, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable. The average NRS pain at rest for all participants who completed the survey at 6 months is reported.
Time frame: 6 months after date of surgery
Least NRS Pain 6 Months After Surgery
Least NRS pain 6 months postoperative, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable. The average least NRS pain for all participants who completed the survey at 6 months is reported.
Time frame: 6 months after date of surgery
Worst NRS Pain 6 Months After Surgery
Least NRS pain 6 months postoperative, measured from 0-10, with 0 being no pain at all to 10 being the worst pain imaginable. The average worst NRS pain for all participants who completed the survey at 6 months is reported.
Time frame: 6 months after date of surgery
Postoperative Knee Injury and Osteoarthritis Outcome (KOOS) Scores
The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a knee-specific instrument, developed to assess the patients' opinion about their knee and associated problems. The KOOS evaluates both short-term and long-term consequences of knee injury. It holds 42 items in 5 separately scored subscales; Pain, other Symptoms, Function in daily living (ADL), Function in Sport and Recreation (Sport/Rec), and knee-related Quality of Life (QOL). A higher score is a better outcome. The score is a percentage score from 0 to 100, 0 representing extreme problems and 100 representing no problems. Although collected at different timepoints, the average score for each participant is calculated and then the average score for all patients is reported.
Time frame: 4 weeks, 3 months, and 6 months after date of surgery
Postoperative painDETECT Scores
PainDETECT is a 9-item self-report screening questionnaire developed to detect NeP in conditions like chronic low back pain. PD-Q measures 7 aspects of the quality of the pain experienced, the chronological pattern (time course), and whether or not the pain radiates. It is scored from 0 to 38, with total scores of \<12 considered = nociceptive pain, 13-18 = possible NeP, and \>19 = \>90% likelihood of NeP. A lower score is a better outcome. Although measured at multiple time points, the average score for each participant is analyzed, and then the average scores for all participants is calculated and reported.
Time frame: 4 weeks, 3 months, and 6 months after date of surgery
Types of Preoperative Medications
Statin, gabapentinoid, anticonvulsant, selective serotonin reuptake inhibitor (SSRI), tricyclic antidepressant, serotonin norepinephrine reuptake inhibitor (SNRI), and opioid and non-opioid pain medications.
Time frame: Before surgery
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