Preoperative glycaemic control, number of pain locations, structural knee damage, self-reported central sensitisation, satisfaction and personal control are predictive of 1-year postoperative pain, and change in pain from pre- to 1-year posttotal knee arthroplasty

Abstract

PurposeThe aim of this study was to identify preoperative predictors for 1-year posttotal knee arthroplasty (TKA) pain and pre- to post-TKA pain difference in knee osteoarthritis (KOA) patients.MethodsFrom March 2018 to July 2023, this prospective longitudinal cohort study enrolled KOA patients awaiting TKA from four hospitals in Belgium and the Netherlands. Different biopsychosocial predictors were assessed preoperatively by questionnaires and physical examinations (input variables). The Knee injury and Osteoarthritis Outcome Score (KOOS) subscale pain was used to measure pain intensity. The absolute KOOS subscale pain score 1-year post-TKA and the difference score (Delta KOOS = 1-year postoperative - preoperative) were used as primary outcome measures (output variables). Two multivariable linear regression analyses were performed.ResultsTwo hundred and twenty-three participants were included after multiple imputation. Worse absolute KOOS subscale pain scores 1-year post-TKA and negative or closer to zero Delta KOOS subscale pain scores were predicted by self-reported central sensitisation, lower KOA grade and preoperative satisfaction, and higher glycated haemoglobin, number of pain locations and personal control (adjusted R2 = 0.25). Additional predictors of negative or closer to zero Delta KOOS subscale pain scores were being self-employed, higher preoperative pain and function (adjusted R2 = 0.37).ConclusionThis study reports different biopsychosocial predictors for both outcomes that have filtered out other potential predictors and provide value for future studies on developing risk assessment tools for the prediction of chronic TKA pain.Protocol RegistrationThe protocol is registered at (NCT05380648) on 13 May 2022.Level of EvidenceLevel II. Self-reported symptoms of central sensitisation, higher glycated haemoglobin, higher preoperative satisfaction, less structural knee damage, higher number of pain locations and better personal control were consistent preoperative predictors of both more pain 1 year after total knee arthroplasty and a pain deterioration or less pain improvement 1 year after total knee arthroplasty. image