ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1979

Post-Arthroplasty Pain Trajectories after Total Knee Arthroplasty and Their Association with 6- and 12-Month Pain

Jasvinder A. Singh1, Lisa Nobel2, Norman Weissman2, Kenneth G. Saag3, Phillip J. Foster4, Jeroan J. Allison5, Celeste Lemay6 and Patricia D. Franklin7, 1Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 2University of Massachusetts, Boston, MA, 3Division Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 4Department of Medicine, Division of Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 5University of Massachusetts Medical School, Worcester, MA, 6Orthopedics, University of Massachusetts Medical School, Worcester, MA, 7Orthopedics & Physical Rehab, University of Massachusetts Medical School, Worcester, MA

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords:

Session Information

Date: Monday, November 14, 2016

Title: Pain – Basic and Clinical Aspects

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Total knee arthroplasty (TKA) is a common elective surgery to treat pain and functional limitation due to refractory arthritis. Post-operative pain is commonly underestimated and undertreated, which can prolong hospital stay, and interfere with engagement in rehabilitation exercises and lead to poorer health-related quality of life (HRQOL). Our objectivewas to examine if immediate post-arthroplasty pain trajectory (pain scores plotted from pre-operative to all time-points post-operative) is associated with long-term pain outcome after total knee arthroplasty (TKA), and assess important correlates of pain trajectories.

Methods:  We used the data from the pain sub-study of the FORCE-TJR study, a nationally representative cohort of U.S. patients (n =28,000) undergoing TKA (or hip arthroplasty) from more than 150 surgeons in 22 states. In a sub-study, patients evaluated pain severity at 2- and 8-weeks after index TKA using a validated survey; pain was assessed on a 0-10 numeric rating scale (NRS). We used group-based trajectory models to determine the number and shape of short-term pain (baseline, 2 weeks, and 8 weeks post-op) trajectories. We then examined the predictive ability of these short-term pain trajectory for longer-term pain outcomes at 6 and 12 months, using multiple linear regression analyses with logit function. Outcomes were Knee injury and Osteoarthritis Outcome Score (KOOS) pain at 6 and 12-months (higher score, worse pain). Multivariable logistic regression adjusted for age, gender, body mass index (BMI), race, Charlson Comorbidity count, and pre-operative health-related quality of life as measured by the SF-36 physical health (PCS) and mental health (MCS) scores.

Results: 659 TKA patients provided 2-week and 8-week pain survey data. The majority of respondents were female (64.5%) and at least 65 years old (66.5%). Among respondents two pain trajectories were evident, with majority being pain responders (72%); i.e. pain decreased in a meaningful way after TKA compared to pre-operative pain) and a smaller proportion were pain non-responders (28%). Early pain trajectory was highly significantly associated with 6- and 12-month pain outcome on KOOS. Additional factors significantly associated at 6 and 12 months were, Charlson Comorbidity count 3, and pre-operative PCS and MCS. African American/other race was significantly associated with pain outcome at 6 months, but not 12 months. Gender, age, and BMI were not significantly associated with pain trajectory at either 6- or 12-months.

Conclusion: We found that pain trajectory up to 8-weeks post-TKA surgery independently predicted longer-term pain outcome. Interventions to modify early post-operative pain experience may lead to better pain outcome (and other patient-reported outcomes) after TKA. Table 1. Predictors of 6- and 12-month KOOSpain scale after TKA among members of FORCE-TJR

6-month

12-month

Coefficient 95% CI; p-value Coefficient 95% CI; p-value
Non-responder Pain Trajectory -11.83 -14.48, 9.17; p<0.001 -10.22 -13.98, -6.46; p<0.001
Age 0.06 -0.08,0.21;p=0.42 0.05 -0.16, 0.27; p=0.63
Gender (Female) 1.82 -0.71, 4.35; p=0.42 1.48 -1.94, 4.91; p=0.40
BMI
25<30 0.30 -3.45, 4.06; p=0.87 -1.75 -7.02, 3.51; p=0.51
30<35 1.52 -2.30,5.33;p=0.44 -1.17 -6.45, 4.12; p=0.67
≥35 1.16 -3.00, 5.32; p=0.59 0.96 -4.79, 6.71; p=0.74
Race
African American/Others -5.73 -10.88, -0.57; p=0.03 1.66 -6.64, 9.95; p=0.69
Charlson Comorbidity Count
1 -1.42 -4.28, 1.44; p=0.33 -2.94 -6.73, 0.86; p=0.13
2 -1.89 -6.13, 2.35; p=0.38 3.72 -2.17, 9.62; p=0.22
>= 3 -7.63 -12.84, -2.42; p<0.001 1.16 -5.99, 8.31; p=0.75
Pre‐op SF-36 MCS 0.30 0.15, 0.45; p<0.001 0.39 0.19, 0.60; p<0.001
Pre‐op SF-36 PCS 0.31 0.21, 0.42; p<0.001 0.32 0.18, 0.47; p<0.001
Disclosure: J. A. Singh, TAP, Savient, 2,Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC and the American College of Rheumatology, 5; L. Nobel, None; N. Weissman, None; K. G. Saag, Amgen, Lilly, Merck, 2,Amgen, Lilly, Merck, 5; P. J. Foster, None; J. J. Allison, None; C. Lemay, Pfizer Inc, 2; P. D. Franklin, None.

To cite this abstract in AMA style:

Singh JA, Nobel L, Weissman N, Saag KG, Foster PJ, Allison JJ, Lemay C, Franklin PD. Post-Arthroplasty Pain Trajectories after Total Knee Arthroplasty and Their Association with 6- and 12-Month Pain [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/post-arthroplasty-pain-trajectories-after-total-knee-arthroplasty-and-their-association-with-6-and-12-month-pain/. Accessed .

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