THE PATIENT EXPERIENCE OF CHRONIC PAIN FOLLOWING TOTAL KNEE REPLACEMENT SURGERY

Abstract

Introduction: The principal aim of total knee replacement (TKR) surgery is to relieve chronic knee pain. However, following recuperation from surgery, 10–30% of patients report chronic pain in the replaced joint. There has been little research investigating the impact of this continuing pain on patients’ lives or exploring the way in which individuals adjust to this pain. Therefore, the aim of this study is to explore, from their own perspectives, patients’ experiences of chronic pain following this end-stage treatment of TKR.

Participants and Methods: Participants were twenty-eight patients who had undergone a TKR with the National Health Service at Bristol, Southwest UK, and who reported chronic pain in the replaced knee joint at least one year post-operatively. Purposive sampling was used in order to recruit participants both of a range of ages and with moderate to severe chronic pain. In-depth, semi-structured interviews were conducted with participants. Interviews explored individuals’ perceptions of the identity of their condition, its cause, duration and consequences and whether they had any control over it. Data was analysed using thematic analysis.

Results: Analysis revealed that, while all participants experienced chronic pain which necessitated the use of pain relief medication, there was great variation among individuals in terms of their adjustment to their condition: while some were well adjusted and accepting of their pain, for others the pain constituted a source of ongoing distress.

Regardless of their expectations concerning level of pain following TKR, those participants who perceived an improvement in pain as a result of their TKR were less likely to expect a cure for their residual pain and were either very well or reasonably well adjusted to the pain. Nevertheless, those who had moderate expectations of outcome were more likely to perceive an improvement than those with high expectations. Those individuals who reported having held high expectations of TKR outcome and subsequently experienced increased pain were likely to experience distress in relation to their pain; those who also felt that a cure for their current pain may be possible experienced particularly high levels of distress.

Discussion: The findings show the significance of cognitions, beliefs and expectations to individuals’ adjustment to chronic pain following TKR. They highlight a group of patients for whom adjustment may be problematic, which could indicate the need for assessment and intervention. There could be potential for surgeons to influence their patients’ adjustment positively by attempting to instil realistic expectations both prior to surgery and when chronic pain is experienced after recovery from TKR.