Abstract
Introduction: Pain is one of the most important outcome measures that contributes to patient dissatisfaction following total knee arthroplasty (TKA) and unexplained pain poses a difficult problem to manage. This paper focuses on a group of patients with unexplained knee pain post arthroplasty to identify any predictors of a poor pain outcome.
Methods: A prospective study of 622 primary TKAs performed on 512 patients using cemented press fit condylar prosthesis was the basis to examine a group of patients that reported moderate or severe pain at 5 years. Demographic and operative variables as well as American Knee Society Scores were collected prospectively. Data was available for 462 knees at 5 years. After exclusion of patients with mild pain, two groups were generated; 374 with no pain and 28 with moderate or severe unexplained pain. Univariate linear analysis was performed to identify possible predictors of poor outcome and this was further refined using multiple regression analysis to remove the effect of confounding factors.
Results: Comparison of the pain and no pain group found the following to be significant predictors of poor outcome: Staged approach to bilateral disease when compared to simultaneous bilateral surgery (13% vs 2%, P< 0.01), age below 60 (17% vs 7%, P< 0.01) and performing lateral release (13% vs 5%, P< 0.01). Other factors which had no predictive effect were gender, body mass index, operating surgeon, patella component, instability and range of motion.
Conclusions: Avoiding surgery in patients aged below 60 and performing simultaneous bilateral TKA instead of a staged approach to bilateral disease, should aid selection of patients for improved outcome in terms of pain. Good surgical technique to avoid lateral release is also recommended to improve outcome.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
