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Postoperative Pain Severity, Incidence of Chronic Pain, and Impact on Daily Function following Oncological Total Knee
Divya Choudhari1, Aparna Chatterjee2, Ashish Gulia3
1Department of Anaesthesia, Critical Care and Pain, ACTREC Hospital, Mumbai, India.
Background:
Oncological Total Knee Replacements(TKR) are complex surgeries compared to Conventional TKR's as they involve morbid resections of bone and soft tissues with reconstructions. Literature on TKR for osteoarthritis, have reported around 10-34% incidence of moderate to severe Chronic post surgical pain(CPSP) which is documented to impact quality of life.
Methodolgy:
We therefore, conducted a prospective observational study of 139 patients over a 38 month period undergoing oncologic TKR to assess the severity of postoperative pain, incidence of CPSP at 4th and 6th months in this subset, identify any neuropathic pain component at 4 and 6th months and its impact on daily function. Adult patients undergoing primary oncological TKR surgeries were included in the study.
Results:
The mean average and worst pain scores were 3.17 (SD± 1.25) and 4.85 (SD±1.60) on the first postoperative day and decreased subsequently over the next 3 days. At 4th month 64 patients (46%) and at 6th month 30 patients (21.6%) continued to have pain, chiefly of mild and some with moderate intensity. The Pain Interference score deduced from Brief Pain Interference(BPI) questionnaire at 4th and 6th month was 1 (0-2.14) and 0 (0-1.29) respectively. At 4 th month, the main aspects which were found to be affected were walking ability and normal work (both outside the home and housework). At 6th month, 10 patients (7.19%) had pain suggestive of neuropathic character as per the pain descriptors used to describe the pain, however on applying the neuropathic questionnaire pain DETECT, all patients had a score below 12 which makes neuropathic pain highly unlikely. The median Musculoskeletal scoring system(MSTS) score was found to be 25 (IQR:24-26) and indicates a good functional outcome at 6 months following oncologic TKR.
Conclusion:
Hence, following oncologic TKR's, the pain was mild in intensity in majority patients. Around 1/5th of the patients had pain of mild intensity at 6 months which was not likely to be neuropathic. Pain did not interfere significantly with daily activities and the functionality as deduced from the MSTS score was good at 6 months.
