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. 2023 Dec 15;12(24):7695.
doi: 10.3390/jcm12247695.

Severe Postoperative Pain in Total Knee Arthroplasty Patients: Risk Factors, Insights and Implications for Pain Management via a Digital Health Approach

Julien Lebleu  1 , Andries Pauwels  1 , Hervé Poilvache  2 , Philippe Anract  3 , Anissa Belbachir  4
Affiliations

Severe Postoperative Pain in Total Knee Arthroplasty Patients: Risk Factors, Insights and Implications for Pain Management via a Digital Health Approach

Julien Lebleu et al. J Clin Med. .

Abstract

Up to 25% of patients undergoing knee arthroplasty report chronic pain postoperatively. Early identification of high-risk individuals can enhance pain management strategies. This retrospective analysis investigates the incidence of severe postoperative pain and its associated risk factors among 740 patients who underwent total knee arthroplasty. Utilizing a digital application, patients provided comprehensive data encompassing pre- and postoperative pain levels, analgesic usage, and completed a chronic pain risk assessment. Participants were categorized into two distinct groups based on their pain status at three months post-op: Group D+ (14%), characterized by pain scores exceeding 40/100 and/or the utilization of level 2 or 3 analgesics, and Group D- (86%), who did not meet these criteria. An analysis of pain trajectories within these groups revealed a non-linear progression, with specific patterns emerging amongst those predisposed to chronic pain. Notably, patients with a trajectory towards chronic pain exhibited a plateau in pain intensity approximately three weeks post-surgery. Significant preoperative risk factors were identified, including elevated initial pain levels, the presence of comorbidities, pain in other body areas, heightened joint sensitivity and stiffness. This study highlights the utility of digital platforms in enhancing patient care, particularly through the continuous monitoring of pain. Such an approach facilitates the early identification of potential complications and enables timely interventions.

Keywords: analgesia; chronic pain; knee surgery; mhealth; pain management; pain trajectory; prehabilitation.

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Conflict of interest statement

Julien Lebleu is an employee of the company who build the software used to collect data Andries Pauwels is an employee of the company who build the software used to collect data. Philippe Anract, Anissa Belbachir and Hervé Poilvache have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Patient application (a) and example of an evolution report showing patient reported outcomes scores against a population and the evolution of daily data (b).
Figure 2
Figure 2
Pain intensity evolution during day and night over the 90 days post-surgery for the whole TKA population.
Figure 3
Figure 3
Pain experienced during the day for the chronic and non-chronic pain group. Rel to surgery: relative to surgery.
Figure 4
Figure 4
Box plots illustrating the distribution of KOOS pain in chronic and non-chronic pain groups over a 2-year duration. PROM: Patient reported outcome score for KOOS pain.
Figure 5
Figure 5
Recovery of physical activity level (number of steps/day) in chronic and non-chronic pain groups. Rel to surgery: relative to surgery.
Figure 6
Figure 6
Patient reported swelling (VAS scale 0–100) in chronic and non-chronic pain groups. Rel to surgery: relative to surgery.
Figure 7
Figure 7
Patient case. Blue bars represent the level of physical activity. The lines represent the pain and the swelling.
See this image and copyright information in PMC

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