Previous standards for assessing the reliability
of a measurement tool have lacked consistency. We reviewed the most
current American Society for Testing and Materials and International
Organisation for Standardisation (ISO) recommendations, and propose
an algorithm for orthopaedic surgeons. When assessing a measurement
tool, conditions of the experimental set-up and clear formulae used
to compile the results should be strictly reported. According to
these recent guidelines, accuracy is a confusing word with an overly
broad meaning and should therefore be abandoned. Depending on the
experimental conditions, one should be referring to bias (when the study
protocol involves accepted reference values), and repeatability
(sr, r) or reproducibility (SR, R). In the absence of accepted reference
values, only repeatability (sr, r) or reproducibility (SR, R) should
be provided. Take home message: Assessing the reliability of a measurement
tool involves reporting bias, repeatability and/or reproducibility
depending on the defined conditions, instead of precision or accuracy. Cite this article:
The patient with a painful arthritic knee awaiting
total knee arthroplasty (TKA) requires a multidisciplinary approach.
Optimal control of acute post-operative pain and the prevention
of chronic persistent pain remains a challenge. The aim of this
paper is to evaluate whether stratification of patients can help
identify those who are at particular risk for severe acute or chronic
pain. Intense acute post-operative pain, which is itself a risk factor
for chronic pain, is more common in younger, obese female patients
and those suffering from central pain sensitisation. Pre-operative
pain, in the knee or elsewhere in the body, predisposes to central
sensitisation. Pain due to osteoarthritis of the knee may also trigger
neuropathic pain and may be associated with chronic medication like
opioids, leading to a state of nociceptive sensitisation called
‘opioid-induced hyperalgesia’. Finally, genetic and personality
related risk factors may also put patients at a higher risk for
the development of chronic pain. Those identified as at risk for chronic pain would benefit from
specific peri-operative management including reduction in opioid
intake pre-operatively, the peri-operative use of antihyperalgesic
drugs such as ketamine and gabapentinoids, and a close post-operative
follow-up in a dedicated chronic pain clinic. Cite this article:
