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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 2, 166-171.
doi: 10.1302/0301-620X.90B2.19640  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Prediction of persistent pain after total knee replacement for osteoarthritis

H. Lundblad, MD, Orthopaedic Surgeon1; A. Kreicbergs, MD, PhD, Professor Emeritus1; and K.-Å. Jansson, MD, PhD, Orthopaedic Surgeon2

1 Department of Orthopaedics
2 Department of Molecular Medicine Karolinska Institute at Karolinska University Hospital, Solna, SE-17176 Stockholm, Sweden.

Correspondence should be sent to Dr H. Lundblad; e-mail: henrik.lundblad{at}karolinska.se

We suggest that different mechanisms underlie joint pain at rest and on movement in osteoarthritis and that separate assessment of these two features with a visual analogue scale (VAS) offers better information about the likely effect of a total knee replacement (TKR) on pain. The risk of persistent pain after TKR may relate to the degree of central sensitisation before surgery, which might be assessed by determining the pain threshold to an electrical stimulus created by a special tool, the Pain Matcher. Assessments were performed in 69 patients scheduled for TKR. At 18 months after operation, separate assessment of pain at rest and with movement was again carried out using a VAS in order to enable comparison of pre- and post-operative measurements. A less favourable outcome in terms of pain relief was observed for patients with a high pre-operative VAS score for pain at rest and a low pain threshold, both features which may reflect a central sensitisation mechanism.




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S. E. Gwilym, T. C. B. Pollard, and A. J. Carr
Understanding pain in osteoarthritis
J Bone Joint Surg Br, March 1, 2008; 90-B(3): 280 - 287.
[Abstract] [Full Text] [PDF]


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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General