Primary total knee arthroplasty in patients with fibromyalgia

No data on the results of total knee arthroplasty (TKA) in patients with fibromyalgia have been published. The purposes of this study were to review a cohort of patients with fibromyalgia undergoing TKA to determine the level of postoperative pain and satisfaction with the surgery, the incidence of postoperative surgical complications, and revision rates and their relationship to TKA design. One hundred ten patients with fibromyalgia (141 knees) who underwent primary TKA between 1990 and 2001 were studied. The average age was 64 years (range, 39-86 years), and the average follow-up was 7 years (range, 2-16 years). Forty-five knees were cruciate retaining, and 96 had a posterior stabilized design. Clinical outcome was assessed using the Knee Society Knee Score and satisfaction regarding the results of the procedure. Postoperative surgical complications and reoperations were obtained from the registry. Sixty-two patients (44%) continued with some pain after TKA. Eighty-five patients (82%) were satisfied with the results. The most common complications were arthrofibrosis and symptomatic instability. The revision rate was 6% (8 knees). Survivorship free from revision at 7 years was 89% for cruciate retaining knees and 98% for posterior stabilized knees. Patients with fibromyalgia undergoing primary TKA have a high prevalence of complications and pain. Despite continued pain, the majority of patients were satisfied with the results and reported improvements after TKA. This data should be used to counsel patients with fibromyalgia preoperatively regarding limited goals with respect to pain relief and suggests that a multimodal individualized treatment program may be necessary to achieve optimal outcomes in patients with fibromyalgia.