CORR Insights®: Widespread Pain Is Associated with Increased Risk of No Clinical Improvement After TKA in Women.

Abstract

All arthroplasty surgeons have encountered a version of this rare-but-devastating situation: A patient returns for follow-up after TKA by a point in time when (s)he should be fully recovered. Examination reveals that the incision has healed well, ligaments are well-balanced, and radiographs show no evidence of malalignment, fracture, or loosening. But the patient reports substantial pain and says it “just doesn’t feel right”. Workup for infection is negative. The situation is upsetting for patient and surgeon alike. Although TKA is one of the most successful operations orthopaedic surgeons perform [14], persistent knee pain for unclear reasons occurs in as many as 8% to 34% of patients [4]. And while a number of patient factors, surgical technique elements, and implant factors may contribute [3, 8], our fundamental understanding of why some patients have this complication is sorely limited. Pain without objective clinical cause after TKA is the focus of awide range of clinical studies that point toward an equally broad array of possible etiologies [6]. Some studies suggest pain without objective etiologymay bemore common in black patients, women, young patients, and patients with lower educational achievement [6, 10, 11]. Other factors that may be associated with persistent pain following TKA include chronic pain remote to the operative knee, fibromyalgia, anxiety, substance use disorders, lack of physical activity in adulthood, and increased acute pain trajectory immediately following TKA [13, 16]. Even genetic polymorphisms are speculated to be associated with persistent post-surgical pain [16]. Widespread pain—a contemporary classification for a number of chronic pain syndromes—encompasses the more-commonly used term of fibromyalgia and includes a broader array of more-nuanced clinical symptoms [18]. The authors of the current study found women (but not men) with widespread pain were more likely not to improve after TKA than were women without widespread pain [17].