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Acute postoperative pain is an independent predictor of chronic postsurgical pain following total knee arthroplasty at 6 months: a prospective cohort study
  1. Asokumar Buvanendran1,
  2. Craig J Della Valle2,
  3. Jeffrey S Kroin1,
  4. Mahendra Shah1,
  5. Mario Moric1,
  6. Kenneth J Tuman1 and
  7. Robert J McCarthy1
  1. 1 Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA
  2. 2 Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, United States
  1. Correspondence to Robert J McCarthy, Department of Anesthesiology, Rush University Medical Center, Chicago, IL 60612, USA; Robert_j_mccarthy{at}


Background Approximately 15% of patients report persistent knee pain despite surgical success following total knee arthroplasty (TKA). The purpose of this study was to determine the association of acute-postsurgical pain (APSP) with chronic postsurgical pain (CPSP) 6 months after TKA controlling for patient, surgical and psychological confounding factors.

Methods Adult patients with osteoarthritis undergoing primary elective tricompartmental TKA, with the operated knee the primary source of preoperative pain, were studied between March 2011 and February 2017. Patients received standard operative management and a perioperative multimodal analgesia regimen. The primary outcome was CPSP at 6 months. The primary variable of interest was the APSP (weighted mean pain score) for 72 hours postoperatively. Patient, surgical and psychological confounders were assessed using binary logistic regression.

Results 245 cases were analyzed. The incidence of CPSP was 14% (95% CI 10% to 19%). Median APSP values were 4.2 (2.2–5.0) in the CPSP group and 2.8 (1.8–3.7) without CPSP, difference 1.4 (95% CI 0.1 to 1.8, p=0.005). The unadjusted odds for CPSP with an increase of 1 in APSP was 1.46 (95% CI 1.14 to 1.87, p=0.002)). After multivariable risk adjustment, the OR for CPSP for an increase of 1 in the APSP was 1.53 (95% CI 1.12 to 2.09, p=0.008).

Conclusions APSP is a risk factor for CPSP following TKA even after adjusting for confounding variables such as pain catastrophizing, anxiety, depression and functional status. Studies are needed to determine if APSP is a modifiable risk factor for the development of CPSP.

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  • Funding This study was supported in part by an investigator-initiated unrestricted grant from Pfizer (WS735224), to Rush University Medical Center with Principal investigator as Asokumar Buvanendran of the Department of Anesthesiology. The funding organization had no role in design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript and decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Institutional Review Board of Rush University (10081110).

  • Provenance and peer review Not commissioned; externally peer reviewed