Knee

Pain after a total knee replacement… What gives???

A recent article in Pain highlighted the effects of presurgical expectancies on the postsurgical outcomes in individuals who have undergone a total knee arthroplasty (TKA). The study appears to be well constructed and followed 120 individuals over a one-year period. It measured: 1. Pain and function via the WOMAC 2. Comorbidities effects on outcomes 3. Pain-related fear of movement via the Tampa Scale for Kinesiophobia 4. Depressive symptoms via the Patient Health Questionnaire 5. Expectancies via four questions (“How likely is it that one month following surgery; your pain will have decreased? your sleep will return to normal? you will have assumed your household responsibilities? you will have resumed your social and recreational activities?) 6. Pain Catastrophizing via the Pain Catastrophizing scale

The results: As previous studies have shown, psychological factors have significant prognostic value in predicting post-operative pain severity and function following a total knee arthroplasty. Presurgical pain catastrophizing predicts poorer recovery as well as pain-related fear of movement and depression.

Recommendation: Prior to having a total joint replacement, individuals who have psychological factors that may impede a good outcome, should undergo pain psychology consultations and treatment to improve post-surgical outcomes.

Fun Fact: Despite objective indicators of surgical success, literature indicates 15-30% of individuals who undergo a TKA will report post-surgical pain and disability.

Sullivan M, Tanzar M, Reardon G, et al. The role of presurgical expectancies in predicting pain and function one year following total knee arthroplasty. Pain 2011.

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