Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Colovic, D.
Evaluation of Neuropathic Pain after Total Knee Arthroplasty
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2023. pp. 99
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Reinbacher Patrick
- Sandner-Kiesling Andreas
- Altmetrics:
- Abstract:
- Background Knee osteoarthritis is a musculoskeletal disease that often leads to a permanent reduction of life quality. When conservative treatments fail, total knee arthroplasty is the current gold standard for alleviating patient suffering. About 15% of patients experience poorly treatable chronic postsurgical pain (CPSP). Factors like young age, female gender, neuropathic pain, pre-existing chronic pain, depression, excessive anxiety, and other yellow flags contribute to worse outcomes. [1] This prospective study aimed to preoperatively identify patients at disproportionate risk of developing CPSP, refining our understanding of the condition. Methods A group of 50 TKA patients underwent preoperative screening, including in depth anamnesis, clinical examination, and collection of PROMs such as the DN4, SF36, WOMAC, FSQ, and HADS. Based on the findings, patients were categorized into high-risk and low-risk groups. Follow-up assessments were conducted over a six-month period to compare clinical outcomes and CPSP development. Results ANOVAs performed after six months indicated significant improvements in subgroups of the SF36 (pain p < 0.001, physical functioning p < 0.001, role physical p < 0.001, energy/fatigue = 0.01), WOMAC (total p < 0.001, pain p < 0.001, stiffness p < 0.001, activity p < 0.001), and NRS in all subgroups (p < 0.001). Significant interaction effects between high-risk and low risk groups were found in the WOMAC subgroups of pain (p = 0.027) and stiffness (p < 0.001) at six months, showing better scores in the high risk group. DN4 scores remained significantly worse in the high risk group one day postoperatively (p = 0.005) and after six weeks (p = 0.041) Conclusion The high-risk group had worse preoperative outcomes, but over time, their results improved and even surpassed the comparison group in pain and stiffness subgroups of the WOMAC after six months. These findings suggest that preoperative neuropathic pain and other risk factors contribute to a more challenging early postoperative period. Nonetheless, TKA can still yield satisfactory outcomes for patients with these conditions.