Preoperative Predictors of Pain Following Total Knee Arthroplasty

摘要

Condylar-type total knee replacement has been performed in the United States for four decades. Implants, surgical techniques and instrumentation have been continuously developed to provide durable results at 20-year follow-up and more [1-5]. Improvements in the development of kinematically functioning designs, user-friendly instruments, peri-operative pain management and accelerated post-operative rehabilitation regimens have been implemented since the beginnings of the operation [6-10]. Although significant improvements in pain and function related to end-stage arthritis of the knee has occurred in millions of patients who have undergone total knee arthroplasty procedures, many studies suggest that an important proportion of total knee replacement recipients are dissatisfied with the procedure and have not had their expectations met [11-14]. Recent reports have demonstrated only 70-88% satisfaction rates following TKA in regards to improvement in function and decrease in pain [11,15-18], and persistent moderate to severe-pain in ten to thirty percent of patients at 1-7 years of follow-up [11,19-21]. These studies have led certain agencies and payors to question whether this commonly performed yet expensive operation should be reimbursed in patients with such reported levels of dissatisfaction as their outcome [22].