Structural Brain Alterations Before and After Total Knee Arthroplasty: A Longitudinal Assessment

Area of Science:

• Neuroscience
• Orthopedics
• Pain Medicine

Background:

• Chronic pain conditions, including knee osteoarthritis (OA), are linked to altered brain structure.
• Brain structural changes may adapt after treatment, but their relationship with nociceptive processing is unclear.

Purpose of the Study:

• Investigate brain structure in knee OA patients before and after total knee arthroplasty (TKA).
• Examine relationships between brain structural changes and quantitative sensory testing (QST) of nociceptive processing.

Main Methods:

• Magnetic resonance imaging (MRI) and QST were used on 29 knee OA patients and 18 controls.
• Voxel-based morphometry and fractional anisotropy analyses were performed before and six months after TKA.

Main Results:

• Knee OA patients showed reduced gray matter and impaired fractional anisotropy before TKA, which improved post-TKA.
• Nociceptive facilitation and impaired inhibition in OA reversed after TKA.
• Minimal correlation was found between MRI findings and QST or pain reports.

Conclusions:

• End-stage knee OA involves gray matter atrophy and white matter integrity changes, improving after TKA.
• Despite functional improvements in nociceptive processing, no association was found with structural brain changes.