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Predictors of Persistent Post-Surgical Pain Following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Observational Studies Publisher Pubmed



Ashoorion V1 ; Sadeghirad B2 ; Wang L3, 4 ; Noori A5 ; Abdar M5 ; Kim Y6 ; Chang Y7 ; Rehman N8 ; Lopes LC9 ; Couban RJ10 ; Aminilari M5 ; Malektojari A11 ; Ghazizadeh S11 ; Rehman Y8, 12 Show All Authors
Authors
  1. Ashoorion V1
  2. Sadeghirad B2
  3. Wang L3, 4
  4. Noori A5
  5. Abdar M5
  6. Kim Y6
  7. Chang Y7
  8. Rehman N8
  9. Lopes LC9
  10. Couban RJ10
  11. Aminilari M5
  12. Malektojari A11
  13. Ghazizadeh S11
  14. Rehman Y8, 12
  15. Ghasemi M13
  16. Adili A14
  17. Guyatt GH5
  18. Busse JW15, 16
Show Affiliations
Authors Affiliations
  1. 1. The Michael G. DeGroote Centre for Medicinal Cannabis Research, The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada
  2. 2. The Michael G. DeGroote National Pain Centre, Department of Anesthesia, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
  3. 3. The Michael G. DeGroote National Pain Centre, Department of Anesthesia, McMaster University, Hamilton, ON, Canada
  4. 4. Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China
  5. 5. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
  6. 6. Faculty of Medicine, University of Western Ontario, London, ON, Canada
  7. 7. OrthoEvidence, Burlington, ON, Canada
  8. 8. Canadian Academy of Osteopathy, Hamilton, ON, Canada
  9. 9. Graduate Program in Pharmaceutical Sciences, University of Sorocaba, State of Sao Paulo, Sorocaba, Brazil
  10. 10. The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada
  11. 11. Hormozgan University of Medical Sciences, Bandarabbas, Iran
  12. 12. The Michael G. DeGroote National Pain Centre, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
  13. 13. Isfahan University of Medical Sciences, Isfahan, Iran
  14. 14. Department of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
  15. 15. The Michael G. DeGroote Centre for Medicinal Cannabis Research, The Michael G. DeGroote National Pain Centre, Department of Anesthesia, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
  16. 16. The Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, ON, Canada

Source: Pain Medicine (United States) Published:2023


Abstract

Objective. Approximately one in four total knee replacement patients develop persistent pain. Identification of those at higher risk could help inform optimal management. Methods. We searched MEDLINE, EMBASE, CINAHL, AMED, SPORTDiscus, and PsycINFO for observational studies that explored the association between risk factors and persistent pain (≥3 months) after total knee replacement. We pooled estimates of association for all independent variables reported by >1 study. Results. Thirty studies (26,517 patients) reported the association of 151 independent variables with persistent pain after knee replacement. High certainty evidence demonstrated an increased risk of persistent pain with pain catastrophizing (absolute risk increase [ARI] 23%, 95% confidence interval [CI] 12 to 35), younger age (ARI for every 10-year decrement from age 80, 4%, 95% CI 2 to 6), and moderate-to-severe acute post-operative pain (ARI 30%, 95% CI 20 to 39). Moderate certainty evidence suggested an association with female sex (ARI 7%, 95% CI 3 to 11) and higher pre-operative pain (ARI 35%, 95% CI 7 to 58). Studies did not adjust for both peri-operative pain severity and pain catastrophizing, which are unlikely to be independent. High to moderate certainty evidence demonstrated no association with pre-operative range of motion, body mass index, bilateral or unilateral knee replacement, and American Society of Anesthesiologists score. Conclusions. Rigorously conducted observational studies are required to establish the relative importance of higher levels of peri-operative pain and pain catastrophizing with persistent pain after knee replacement surgery. VC The Author(s) 2022.
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