title: An examination of the effect of different methods of scoring pain after a total knee replacement on the number of patients who report unchanged or worse pain.
abstract: We identified a group of patients from the Swedish Arthroplasty Register who reported no relief of pain or worse pain one year after a total knee replacement (TKR). A total of two different patient-reported pain scores were used during this process. We then evaluated how the instruments used to measure pain affected the number of patients who reported no relief of pain or worse pain, and the relative effect of potential risk factors. Between 2008 and 2010, 2883 TKRs were performed for osteoarthritis in two Swedish arthroplasty units. After applying exclusion criteria, 2123 primary TKRs (2123 patients) were included in the study. The Knee injury and Osteoarthritis Outcome Score (KOOS) and a Visual Analogue Scale (VAS) for knee pain were used to assess patients pre-operatively and one year post-operatively. Only 50 of the 220 patients (23%) who reported no pain relief on either the KOOS pain subscale or the VAS for knee pain did so with both of these instruments. Patients who reported no pain relief on either measure tended to have less pain pre-operatively but a higher degree of anxiety. Charnley category C was a predictor for not gaining pain relief as measured on a VAS for knee pain. The number of patients who are not relieved of pain after a TKR differs considerably depending on the instrument used to measure pain.
authors.affiliation: Lund University, Department of Orthopaedics, Skane University Hospital, Lund, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: W-Dahl
authors.affiliation: Lund University, Department of Orthopaedics, Skane University Hospital, Lund, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Sundberg
authors.affiliation: Lund University, Department of Orthopaedics, Skane University Hospital, Lund, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Lidgren
authors.affiliation: Lund University, RCSyd, Skane University Hospital, Lund, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Ranstam
authors.affiliation: Lund University, Department of Orthopaedics, Skane University Hospital, Lund, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Robertsson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Osteoarthritis; Outcome measures; Pain; Register; Risk factors; Total knee replacement