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Observational Study
. 2021 Dec 31;16(12):e0261850.
doi: 10.1371/journal.pone.0261850. eCollection 2021.

Risk factors associated with poor pain outcomes following primary knee replacement surgery: Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme

Hasan Raza Mohammad  1 , Rachael Gooberman-Hill  2   3 , Antonella Delmestri  1   4 , John Broomfield  1 , Rita Patel  2 , Joerg Huber  5 , Cesar Garriga  1   6 , Christopher Eccleston  7 , Rafael Pinedo-Villanueva  1 , Tamer T Malak  1 , Nigel Arden  1 , Andrew Price  1 , Vikki Wylde  2   3 , Tim J Peters  8 , Ashley W Blom  2   3 , Andrew Judge  1   2   3   4
Affiliations
Observational Study

Risk factors associated with poor pain outcomes following primary knee replacement surgery: Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme

Hasan Raza Mohammad et al. PLoS One. .

Abstract

Objective: Identify risk factors for poor pain outcomes six months after primary knee replacement surgery.

Methods: Observational cohort study on patients receiving primary knee replacement from the UK Clinical Practice Research Datalink, Hospital Episode Statistics and Patient Reported Outcomes. A wide range of variables routinely collected in primary and secondary care were identified as potential predictors of worsening or only minor improvement in pain, based on the Oxford Knee Score pain subscale. Results are presented as relative risk ratios and adjusted risk differences (ARD) by fitting a generalized linear model with a binomial error structure and log link function.

Results: Information was available for 4,750 patients from 2009 to 2016, with a mean age of 69, of whom 56.1% were female. 10.4% of patients had poor pain outcomes. The strongest effects were seen for pre-operative factors: mild knee pain symptoms at the time of surgery (ARD 18.2% (95% Confidence Interval 13.6, 22.8), smoking 12.0% (95% CI:7.3, 16.6), living in the most deprived areas 5.6% (95% CI:2.3, 9.0) and obesity class II 6.3% (95% CI:3.0, 9.7). Important risk factors with more moderate effects included a history of previous knee arthroscopy surgery 4.6% (95% CI:2.5, 6.6), and use of opioids 3.4% (95% CI:1.4, 5.3) within three months after surgery. Those patients with worsening pain state change had more complications by 3 months (11.8% among those in a worse pain state vs. 2.7% with the same pain state).

Conclusions: We quantified the relative importance of individual risk factors including mild pre-operative pain, smoking, deprivation, obesity and opioid use in terms of the absolute proportions of patients achieving poor pain outcomes. These findings will support development of interventions to reduce the numbers of patients who have poor pain outcomes.

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Conflict of interest statement

All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf and declare: AJ reports grants from NIHR PGfAR, during the conduct of the study; personal fees from Freshfields Bruckhaus Derringer, personal fees from Anthera Pharmaceuticals Ltd, outside the submitted work; RGH reports grants from NIHR PGfAR, during the conduct of the study. HRM reports grants from Royal College of Surgeons Research Fellowship, outside the submitted work; RPV reports research funding from UK-NIHR, Kyowa Kirin Services, International Osteoporosis Foundation, and lecture fees and/or consulting honoraria from Amgen, UCB, Kyowa Kirin Services, and Mereo Biopharma, all outside of the scope of this study; NA reports personal fees from Pfizer/Lilly, personal fees from Bristows LLP, grants from Merck Grant, outside the submitted work; VW reports grants from NIHR, during the conduct of the study; TJP reports grants from UK NIHR Programme Grant for Applied Research, during the conduct of the study. All other authors declare no conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Patient flow diagram.
TKR/UKR, total and uni-compartmental knee replacement; CPRD, Clinical Practice Research Datalink GOLD; HES, English Hospital Episode Statistics; PROMs, Patient Reported Outcome Measures; OKS, Oxford Knee Score; Underweight BMI, Body Mass Index under 18.5 Kg/m2.
Fig 2
Fig 2. Distribution of the treatment effect score for patients who did, and did not, respond to surgery.
Red = poor pain outcome, Blue = good pain outcome.
Fig 3
Fig 3. Forest plot of predictors of poor pain outcomes.
Fig 4
Fig 4. Adjusted risk differences for predictors of poor pain outcomes.
See this image and copyright information in PMC

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