Clinical Orthopaedics and Related Research: January 2015 - Volume 473 - Issue 1 - p 246–254 doi: 10.1007/s11999-014-3990-2 Clinical Research

Abnormal Quantitative Sensory Testing is Associated With Persistent Pain One Year After TKA

Wright, Anthony, PhD1; Moss, Penny, PhD1,a; Sloan, Karen, MSc2; Beaver, Richard, J., FRACS2; Pedersen, Jarle, B., MClinPhysio1; Vehof, Gerard, MClinPhysio1; Borge, Henrik, MClinPhysio1; Maestroni, Luca, MClinPhysio1; Cheong, Philip, MManipTher1
Knee

Background Up to 15% of patients report at least moderate persistent pain after TKA. Such pain may be associated with the presence of widespread hyperalgesia and neuropathic-type pain.

Questions/purposes We asked if there was a difference among patients who report moderate to severe pain or no pain at least 12 months after TKA regarding (1) pressure pain threshold, (2) thermal (cold/heat) pain and detection thresholds, and (3) self-reported neuropathic pain.

Patients and Method Fifty-three volunteers were recruited from patients reporting no pain or moderate to severe pain, according to the Knee Society Score©. Differences between the moderate-to-severe and no-pain groups regarding pressure pain, heat and cold thresholds, and self-reported neuropathic-type pain were analyzed using independent t-tests.

 

Results Patients in the moderate-to-severe pain group exhibited reduced pressure pain threshold in the knee with the TKA (p = 0.025) and at the elbow (p = 0.002). This group also showed greater pain sensitivity to cold at the knee (p = 0.008) and elbow (p = 0.010), and increased heat pain sensitivity at the elbow (p = 0.032). Cold and heat detection thresholds were impaired in this group at the elbow (cold, p = 0.034; heat, p = 0.010), although only heat detection was impaired at the knee (p = 0.009). The moderate-to-severe pain group also reported more neuropathic-type pain (p = 0.001).

 

Conclusion Persistent pain after TKA was associated with widespread pressure, cold hyperalgesia, and greater neuropathic-type pain.

 

Level of Evidence Level III, prognostic study.


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