2015 ISAKOS Biennial Congress Paper #0

Central Sensitization and Neuropathic Pain Synergistically Affect Inferior Patients Reported Outcomes Following Total Knee Arthroplasty

Man-Soo Kim, MD, PhD, Seoul KOREA, REPUBLIC OF
Dongho Kwak, MD, Seoul KOREA, REPUBLIC OF
Sungcheol Yang, MD, Seoul KOREA, REPUBLIC OF
Hyukjin Jang, MD, Seoul KOREA, REPUBLIC OF
Ryu Kyoung Cho, MD, Seoul KOREA, REPUBLIC OF
Yong In, MD, PhD, Seoul KOREA, REPUBLIC OF

Seoul St. Mary's Hospital, Seoul, KOREA, REPUBLIC OF

FDA Status Cleared

Summary: Central Sensitization and Neuropathic Pain symptom were factors related to higher postoperative pain levels and inferior PROMs in patients undergoing primary TKA

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Abstract:

Introduction

There are still insufficient studies on the relationship between central sensitization (CS) and neuropathic pain (NP), and the effects of CS and NP on the patient-reported outcome measures (PROMs) of patients who underwent total knee arthroplasty (TKA). The purpose of this study was to investigate the relationship between CS and NP and whether CS and NP were associated with PROM in patients undergoing TKA.

Methods

A total of 312 patients who underwent primary TKA for end stage knee OA were enrolled. CS was defined as a patient with a score of 40 or higher using central sensitization inventory (CSI). NP was defined as a patient with a score of 13 or more using pain detect questionnaire (PDQ). PROMs were also evaluated based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score preoperatively and at postoperative 2 years. The patients were divided into 4 groups, group 1 with CS and NP positive, group 2 with only CS positive, group 3 with only NP positive, and group 4 with CS and NP negative, and PROM was compared between the groups.

Results

There were 90 patients (28.5%) with both CS and NP positive, 33 patients (10.4%) with only CS positive, and 83 patients (26.3%) with only NP positive and 110 patients (34.8%) with CS and NP negative. All WOMAC subscores showed significant differences between the 4 groups before and after surgery (all p < 0.05). As a result of post hoc analysis before surgery, group 1 showed significantly inferior WOMAC pain, function, and total score compared to groups 2, 3, and 4 (all p < 0.05). Groups 2 and 3 showed worse preoperative results in WOMAC subscores compared to group 4 (all p < 0.05). These results remained the same at 2 years after surgery.

Conclusion

CS and NP symptom were factors related to higher postoperative pain levels and inferior PROMs in patients undergoing primary TKA. Among them, those with both CS and NP positive showed an inferior postoperative PROM compared to only CS or NP positive, and both CS and NP negative.