Highlights
- •Composite scores of multiple measures to fully reflect pain outcomes in addition to pain plus other symptoms outcomes were developed for patients undergoing knee arthroplasty.
- •Complete resolution of pain in the index knee occurs in about a third of the time after knee replacement surgery recovery.
- •Complete pain plus other symptoms resolution is much less frequent, ∼14% of the time.
- •Complete functional restoration occurred in ∼29% of subjects.
- •These findings can more fully inform shared decision-making discussions with patients.
Abstract
Objectives
To determine the prevalence of a 1- to 2-year postsurgical pain-free state and pain
plus symptom-free state as well as functional restoration after knee arthroplasty
(KA) and to identify predictors of these outcomes.
Design
Cohort study.
Setting
Communities of 4 sites.
Participants
Consecutive participants (N=383) who underwent KA on at least 1 knee during the first
8 years of the study (mean age, 67.95±8.5y; 61.4% women; n=235).
Interventions
Not applicable.
Main Outcome Measures
A composite pain score included the Western Ontario and McMaster Universities Osteoarthritis
Index (WOMAC) Pain scale and 2 generic pain rating scales. Composite pain plus other
symptoms scores included 3 pain scales, a stiffness scale, and, in addition, the Knee
injury and Osteoarthritis Outcome Score Symptoms scale. The WOMAC Function scale was
used to quantify functional status. Prevalence estimates and predictors of a pain-free
state, symptom-free state, and a fully functioning state were determined.
Results
A sample of 383 participants with KA was studied, and of these, 34.1% (95% confidence
interval [CI], 29.3%–39.2%; n=131) had a composite score of 0 for pain. A total of
14.1% (95% CI, 10.8%–18.1%; n=54) had a composite score of 0, indicating a symptom-free
state, whereas 29.0% (95% CI, 24.4%–34.0%; n=111) achieved a score of 0 on the WOMAC
Function scale.
Conclusions
The prevalence of complete pain relief was 34%, the prevalence of complete pain and
symptom relief was 14%, and the prevalence of complete functional restoration was
29% after KA. Participants who are older and with lower (better) WOMAC Pain scores
were more likely to be pain-free after surgery. These data collected from a community-based
sample have the potential to inform clinicians screening patients for KA consultation
in a shared decision-making discussion to better align patient expectations with the
most likely outcome.
Keywords
List of abbreviations:
CI (Confidence interval), KA (Knee arthroplasty), KOOS (Knee injury and Osteoarthritis Outcome Score), OAI (Osteoarthritis Initiative), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 09, 2018
Footnotes
Supported by the Osteoarthritis Initiative (OAI), a public a public-private partnership composed of 5 contracts (contract nos. N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This article was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI Study Investigators, the National Institutes of Health, or the private funding partners.
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
