High levels of preoperative pain and fatigue are red flagsfor moderate‐severe pain 12 months after total kneearthroplasty—A longitudinal cohort study
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Original versionEnbakom, Lerdal, Småstuen, Gay, Aamodt, Tesfaye, Lindberg. High levels of preoperative pain and fatigue are red flagsfor moderate‐severe pain 12 months after total kneearthroplasty—A longitudinal cohort study. Musculoskeletal Care. 2020:1-7 https://doi.org/10.1002/msc.1522
Background: Moderate/severe pain after total knee arthroplasty (TKA) is a poor surgical outcome. Many studies have identiﬁed preoperative risk factors of painafter TKA, but studies of the joint contributions of co-occurring symptoms arelacking. Methods: Patients undergoing primary TKA (n=202) were enrolled in a longitu-dinal cohort study. Preoperatively, patients completed questionnaires measuring demographics and symptoms (pain, fatigue, sleep problems and depression). Painwas re-assessed 12 months after TKA. Logistic regression analysis was used to compute the probabilities of moderate-severe pain at 12 months based on preoperative symptom levels, and results were combined into a risk matrix. Results: More than one-third (40%) of patients (n=187) reported moderate-severepain after TKA. Among preoperative risk factors included in the logistic regressionanalyses were age, sex, pain, fatigue, sleep problems and depression. Adjusting forpossible confounders, fatigue (p=0.02) and pain (p=0.01) were signiﬁcant riskfactors for moderate-severe pain at 12-months follow-up and were retained in the ﬁnal risk matrix. The co-occurrence of high-preoperative fatigue and pain scores resulted in 57% estimated probability of moderate-severe pain at 12 months.Similarly, the co-occurrence of low-preoperative fatigue and pain scores resulted in14% estimated probability of moderate-severe pain 12 months after TKA. Conclusion: The combination of high fatigue and pain scores prior to surgery was akey risk factor for moderate-severe pain 12 months after TKA. Mapping of these factors could be used preoperatively to identify patients who are at risk to expe-rience a poor outcome of TKA.