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Satisfaction and Persistent Pain Outcomes After Knee Arthroplasty: A Prospective Cohort Study
Imad Kashir1, Harsha Shanthanna2, Vickas Khanna3
1Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
Background:
Knee arthroplasty relieves pain and improves function for most patients who have end-stage knee osteoarthritis. However, up to one in four patients experience chronic postsurgical pain (CPSP), which is associated with opioid use, dissatisfaction, delayed recovery, and reduced quality of life. Psychological factors, such as preoperative coping and mental health, may influence these outcomes, but their role in recovery from elective knee surgery is not well understood. Our primary objective was to determine the prevalence of CPSP at six months; secondary objectives were to determine the prevalence of CPSP at three and 12 months, the prevalence of dissatisfaction and opioid use at three, six, and 12 months, and to evaluate baseline predictors of these outcomes.
Methods:
We prospectively enrolled 302 patients undergoing total or partial knee arthroplasty. We collected follow-up data at one, three, six, and 12 months postsurgery through surveys and electronic health records. Outcomes included CPSP, defined by a score ≥ 4 on a 0 to 10-point numeric rating scale for pain; opioid use, assessed through self-report and chart review; and patient satisfaction, measured by the Self-Administered Patient Satisfaction Scale. We constructed multivariable regression models to evaluate the association between baseline factors and each outcome.
Results:
The prevalence of moderate to severe CPSP was 17.1% at six months and 12.7% at 12 months. Higher preoperative numeric rating scale pain scores predicted CPSP at six months (P = 0.007) and 12 months (P = 0.006). Depression scores predicted dissatisfaction at six months (P = 0.020). The 4-week Somatic Preoccupation and Coping scores were associated with dissatisfaction at all time points. There were no predictors of prolonged opioid use were identified.
Conclusions:
In this prospective cohort study, CPSP and dissatisfaction after knee arthroplasty were identified in ≥ 10% of patients as important negative outcomes persisting even at 12 months. We identified important risk factors that could be modified to improve these outcomes.
Level Of Evidence:
IV.
