Skip to main content
SpringerLink
Log in

Pain after knee arthroplasty: an unresolved issue

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Despite the recent advances in the understanding of pain mechanisms and the introduction of new drugs and new techniques in the postoperative management, pain after total knee arthroplasty (TKA) is still an unresolved issue. It affects the quality of life and rehabilitation of an important percentage of patients undergoing TKA. The aim of this narrative review was to give an overview on pain mechanisms and multimodal pain management.

Methods

A review of all peer-reviewed articles on pain after knee arthroplasty was performed by two reviewers. Recent articles on incisional pain mechanisms were included because of their importance in the understanding of postsurgical pain. Search was performed in Pubmed, Cochrane and Google Scholar data bases.

Results

Postsurgical pain mechanisms are based on both local and systemic inflammatory reactions. Peri-operative pain management starts with the anaesthetic technique and resides on a multimodal analgesia regimen. New concepts, drugs and techniques have shown their efficacy in reducing the severity of acute postoperative pain and the risk of developing chronic pain after TKA.

Conclusion

This narrative review offers a clear overview of pain mechanism after knee arthroplasty and an understanding on how multimodal pain management can reduce the intensity and duration of pain after knee arthroplasty.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Abdallah FW, Brull R (2011) Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? A systematic review. Reg Anesth Pain Med 36:493–498

    PubMed  Google Scholar 

  2. Adam F, Chauvin M, Du Manoir B, Langlois M, Sessler DI, Fletcher D (2005) Small-dose ketamine infusion improves postoperative analgesia and rehabilitation after total knee arthroplasty. Anesth Analg 100:475–480

    CAS  PubMed Central  PubMed  Google Scholar 

  3. Alam A, Gomes T, Zheng H, Mamdani MM, Juurlink DN, Bell CM (2012) Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med 172:425–430

    PubMed  Google Scholar 

  4. Allegri M, Clark MR, De Andres J, Jensen TS (2012) Acute and chronic pain: where we are and where we have to go. Minerva Anestesiol 78:222–235

    CAS  PubMed  Google Scholar 

  5. Andersen HL, Gyrn J, Moller L, Christensen B, Zaric D (2013) Continuous saphenous nerve block as supplement to single-dose local infiltration analgesia for postoperative pain management after total knee arthroplasty. Reg Anesth Pain Med 38:106–111

    CAS  PubMed  Google Scholar 

  6. Andersen KV, Bak M, Christensen BV, Harazuk J, Pedersen NA, Soballe K (2010) A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty. Acta Orthop 81:606–610

    Google Scholar 

  7. Andersen LO, Gaarn-Larsen L, Kristensen BB, Husted H, Otte KS, Kehlet H (2009) Subacute pain and function after fast-track hip and knee arthroplasty. Anaesthesia 64:508–513

    CAS  PubMed  Google Scholar 

  8. Andersen LO, Husted H, Kristensen BB, Otte KS, Gaarn-Larsen L, Kehlet H (2010) Analgesic efficacy of intracapsular and intra-articular local anaesthesia for knee arthroplasty. Anaesthesia 65:904–912

    Google Scholar 

  9. Andersen LO, Husted H, Kristensen BB, Otte KS, Gaarn-Larsen L, Kehlet H (2008) Analgesic efficacy of subcutaneous local anaesthetic wound infiltration in bilateral knee arthroplasty: a randomised, placebo-controlled, double-blind trial. Acta Anaesthesiol Scand 54:543–548

    Google Scholar 

  10. Andersen LO, Husted H, Otte KS, Kristensen BB, Kehlet H (2008) High-volume infiltration analgesia in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Acta Anaesthesiol Scand 52:1331–1335

    CAS  PubMed  Google Scholar 

  11. Apfelbaum JL, Chen C, Mehta SS, Gan TJ (2003) Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 97:534–540

    PubMed  Google Scholar 

  12. Arendt-Nielsen L, Nie H, Laursen MB, Laursen BS, Madeleine P, Simonsen OH, Graven-Nielsen T (2010) Sensitization in patients with painful knee osteoarthritis. Pain 149:573–581

    PubMed  Google Scholar 

  13. Aveline C, Gautier JF, Vautier P, Cognet F, Hetet HL, Attali JY, Leconte V, Leborgne P, Bonnet F (2009) Postoperative analgesia and early rehabilitation after total knee replacement: a comparison of continuous low-dose intravenous ketamine versus nefopam. Eur J Pain 13:613–619

    CAS  PubMed  Google Scholar 

  14. Bagry H, de la Cuadra Fontaine JC, Asenjo JF, Bracco D, Carli F (2008) Effect of a continuous peripheral nerve block on the inflammatory response in knee arthroplasty. Reg Anesth Pain Med 33:17–23

    PubMed  Google Scholar 

  15. Bergeron SG, Kardash KJ, Huk OL, Zukor DJ, Antoniou J (2009) Functional outcome of femoral versus obturator nerve block after total knee arthroplasty. Clin Orthop Relat Res 467:1458–1462

    PubMed Central  PubMed  Google Scholar 

  16. Bernucci F, Carli F (2012) Functional outcome after major orthopedic surgery: the role of regional anesthesia redefined. Curr Opin Anaesthesiol 25:621–628

    PubMed  Google Scholar 

  17. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P (2012) What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2:e00043518

    Google Scholar 

  18. Blaudszun G, Lysakowski C, Elia N, Tramer MR (2012) Effect of perioperative systemic alpha2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology 116:1312–1322

    CAS  PubMed  Google Scholar 

  19. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63

    PubMed Central  PubMed  Google Scholar 

  20. Bramlett K, Onel E, Viscusi ER, Jones K (2012) A randomized, double-blind, dose-ranging study comparing wound infiltration of DepoFoam bupivacaine, an extended-release liposomal bupivacaine, to bupivacaine HCl for postsurgical analgesia in total knee arthroplasty. Knee 19:530–536

    PubMed  Google Scholar 

  21. Brennan TJ (2011) Pathophysiology of postoperative pain. Pain 152:S33–S40

    PubMed Central  PubMed  Google Scholar 

  22. Buvanendran A, Kroin JS, Berger RA, Hallab NJ, Saha C, Negrescu C, Moric M, Caicedo MS, Tuman KJ (2006) Upregulation of prostaglandin E2 and interleukins in the central nervous system and peripheral tissue during and after surgery in humans. Anesthesiology 104:403–410

    CAS  PubMed  Google Scholar 

  23. Buvanendran A, Kroin JS, Della Valle CJ, Kari M, Moric M, Tuman KJ (2010) Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial. Anesth Analg 110:199–207

    CAS  PubMed  Google Scholar 

  24. Buvanendran A, Kroin JS, Della Valle CJ, Moric M, Tuman KJ (2012) Cerebrospinal fluid neurotransmitter changes during the perioperative period in patients undergoing total knee replacement: a randomized trial. Anesth Analg 114:434–441

    CAS  PubMed  Google Scholar 

  25. Cappelleri G, Ghisi D, Fanelli A, Albertin A, Somalvico F, Aldegheri G (2011) Does continuous sciatic nerve block improve postoperative analgesia and early rehabilitation after total knee arthroplasty? A prospective, randomized, double-blinded study. Reg Anesth Pain Med 36:489–492

    PubMed  Google Scholar 

  26. Carli F, Charlebois P, Stein B, Feldman L, Zavorsky G, Kim DJ, Scott S, Mayo NE (2010) Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg 97:1187–1197

    CAS  PubMed  Google Scholar 

  27. Carli F, Clemente A, Asenjo JF, Kim DJ, Mistraletti G, Gomarasca M, Morabito A, Tanzer M (2011) Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. Br J Anaesth 105:185–195

    Google Scholar 

  28. Carli F, Kehlet H, Baldini G, Steel A, McRae K, Slinger P, Hemmerling T, Salinas F, Neal J (2011) Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways. Reg Anesth Pain Med 36:63–72

    CAS  PubMed  Google Scholar 

  29. Carroll I, Barelka P, Wang CK, Wang BM, Gillespie MJ, McCue R, Younger JW, Trafton J, Humphreys K, Goodman SB, Dirbas F, Whyte RI, Donington JS, Cannon WB, Mackey SC (2012) A pilot cohort study of the determinants of longitudinal opioid use after surgery. Anesth Analg 115:694–702

    PubMed  Google Scholar 

  30. Chapman CR, Donaldson GW, Davis JJ, Bradshaw DH (2011) Improving individual measurement of postoperative pain: the pain trajectory. J Pain 12:257–262

    PubMed Central  PubMed  Google Scholar 

  31. Charous MT, Madison SJ, Suresh PJ, Sandhu NS, Loland VJ, Mariano ER, Donohue MC, Dutton PH, Ferguson EJ, Ilfeld BM (2011) Continuous femoral nerve blocks: varying local anesthetic delivery method (bolus versus basal) to minimize quadriceps motor block while maintaining sensory block. Anesthesiology 115:774–781

    PubMed Central  PubMed  Google Scholar 

  32. Chaumeron A, Audy D, Drolet P, Lavigne M, Vendittoli PA (2013) Periarticular injection in knee arthroplasty improves quadriceps function. Clin Orthop Relat Res 471:2284–2295

    PubMed Central  PubMed  Google Scholar 

  33. Choi PT, Bhandari M, Scott J, Douketis J (2003) Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database Syst Rev 3:CD003071

    Google Scholar 

  34. Cook P, Stevens J, Gaudron C (2003) Comparing the effects of femoral nerve block versus femoral and sciatic nerve block on pain and opiate consumption after total knee arthroplasty. J Arthroplasty 18:583–586

    PubMed  Google Scholar 

  35. Cremeans-Smith JK, Millington K, Sledjeski E, Greene K, Delahanty DL (2006) Sleep disruptions mediate the relationship between early postoperative pain and later functioning following total knee replacement surgery. J Behav Med 29:215–222

    PubMed  Google Scholar 

  36. Cross WW 3rd, Saleh KJ, Wilt TJ, Kane RL (2006) Agreement about indications for total knee arthroplasty. Clin Orthop Relat Res 446:34–39

    PubMed  Google Scholar 

  37. Cullen BF, Haschke RH (1974) Local anesthetic inhibition of phagocytosis and metabolism of human leukocytes. Anesthesiology 40:142–146

    CAS  PubMed  Google Scholar 

  38. Dahl V, Spreng UJ, Waage M, Raeder JC (2012) Short stay and less pain after ambulatory anterior cruciate ligament (ACL) repair: COX-2 inhibitor versus glucocorticoid versus both combined. Acta Anaesthesiol Scand 56:95–101

    CAS  PubMed  Google Scholar 

  39. De Kock M, Loix S, Lavand’homme P (2013) Ketamine and peripheral inflammation. CNS Neurosci Ther 19:403–410

    PubMed  Google Scholar 

  40. Dickstein R, Heffes Y, Shabtai EI, Markowitz E (1998) Total knee arthroplasty in the elderly: patients’ self-appraisal 6 and 12 months postoperatively. Gerontology 44:204–210

    CAS  PubMed  Google Scholar 

  41. Edwards RR, Smith MT, Stonerock G, Haythornthwaite JA (2006) Pain-related catastrophizing in healthy women is associated with greater temporal summation of and reduced habituation to thermal pain. Clin J Pain 22:730–737

    PubMed  Google Scholar 

  42. Elia N, Lysakowski C, Tramer MR (2005) Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology 103:1296–1304

    CAS  PubMed  Google Scholar 

  43. Essving P, Axelsson K, Aberg E, Spannar H, Gupta A, Lundin A (2011) Local infiltration analgesia versus intrathecal morphine for postoperative pain management after total knee arthroplasty: a randomized controlled trial. Anesth Analg 113:926–933

    CAS  PubMed  Google Scholar 

  44. Feibel RJ, Dervin GF, Kim PR, Beaule PE (2009) Major complications associated with femoral nerve catheters for knee arthroplasty: a word of caution. J Arthroplasty 24:132–137

    PubMed  Google Scholar 

  45. Fletcher D, Fermanian C, Mardaye A, Aegerter P (2008) A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges. Pain 137:441–451

    PubMed  Google Scholar 

  46. Fowler SJ, Symons J, Sabato S, Myles PS (2008) Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth 100:154–164

    CAS  PubMed  Google Scholar 

  47. Gelfand HJ, Ouanes JP, Lesley MR, Ko PS, Murphy JD, Sumida SM, Isaac GR, Kumar K, Wu CL (2011) Analgesic efficacy of ultrasound-guided regional anesthesia: a meta-analysis. J Clin Anesth 23:90–96

    PubMed  Google Scholar 

  48. Gentili M, Enel D, Szymskiewicz O, Mansour F, Bonnet F (2001) Postoperative analgesia by intraarticular clonidine and neostigmine in patients undergoing knee arthroscopy. Reg Anesth Pain Med 26:342–347

    CAS  PubMed  Google Scholar 

  49. Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W (2013) Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology 118:934–944

    PubMed  Google Scholar 

  50. Grosu I, De Kock M (2011) New concepts in acute pain management: strategies to prevent chronic postsurgical pain, opioid-induced hyperalgesia, and outcome measures. Anesthesiol Clin 29:311–327

    PubMed  Google Scholar 

  51. Haroutiunian S, Nikolajsen L, Finnerup NB, Jensen TS (2013) The neuropathic component in persistent postsurgical pain: a systematic literature review. Pain 154:95–102

    PubMed  Google Scholar 

  52. Harsten A, Kehlet H, Toksvig-Larsen S (2013) Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty: a randomized trial. Br J Anaesth 111:391–399

    CAS  PubMed  Google Scholar 

  53. Henningsen MH, Jaeger P, Hilsted KL, Dahl JB (2013) Prevalence of saphenous nerve injury after adductor-canal-blockade in patients receiving total knee arthroplasty. Acta Anaesthesiol Scand 57:112–117

    CAS  PubMed  Google Scholar 

  54. Hepinstall MS, Rutledge JR, Bornstein LJ, Mazumdar M, Westrich GH (2011) Factors that impact expectations before total knee arthroplasty. J Arthroplasty 26:870–876

    PubMed  Google Scholar 

  55. Hofmann S, Seitlinger G, Djahani O, Pietsch M (2011) The painful knee after TKA: a diagnostic algorithm for failure analysis. Knee Surg Sports Traumatol Arthrosc 19:1442–1452

    CAS  PubMed  Google Scholar 

  56. Hollmann MW, Durieux ME (2000) Local anesthetics and the inflammatory response: a new therapeutic indication? Anesthesiology 93:858–875

    CAS  PubMed  Google Scholar 

  57. Hu WS, Muscoplat CC (1980) Lidocaine: effect on phagocytosis and purification of monocytes in bovine peripheral blood. Am J Vet Res 41:447–449

    CAS  PubMed  Google Scholar 

  58. Hurley RW, Adams MC (2008) Sex, gender, and pain: an overview of a complex field. Anesth Analg 107:309–317

    PubMed Central  PubMed  Google Scholar 

  59. Ilfeld BM, Duke KB, Donohue MC (2010) The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg 111:1552–1554

    PubMed Central  PubMed  Google Scholar 

  60. Ilfeld BM, Le LT, Meyer RS, Mariano ER, Vandenborne K, Duncan PW, Sessler DI, Enneking FK, Shuster JJ, Theriaque DW, Berry LF, Spadoni EH, Gearen PF (2008) Ambulatory continuous femoral nerve blocks decrease time to discharge readiness after tricompartment total knee arthroplasty: a randomized, triple-masked, placebo-controlled study. Anesthesiology 108:703–713

    CAS  PubMed Central  PubMed  Google Scholar 

  61. Ilfeld BM, Shuster JJ, Theriaque DW, Mariano ER, Girard PJ, Loland VJ, Meyer S, Donovan JF, Pugh GA, Le LT, Sessler DI, Ball ST (2011) Long-term pain, stiffness, and functional disability after total knee arthroplasty with and without an extended ambulatory continuous femoral nerve block: a prospective, 1-year follow-up of a multicenter, randomized, triple-masked, placebo-controlled trial. Reg Anesth Pain Med 36:116–120

    PubMed Central  PubMed  Google Scholar 

  62. Ip HY, Abrishami A, Peng PW, Wong J, Chung F (2009) Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology 111:657–677

    PubMed  Google Scholar 

  63. Jaeger P, Nielsen ZJ, Henningsen MH, Hilsted KL, Mathiesen O, Dahl JB (2013) Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology 118:409–415

    CAS  PubMed  Google Scholar 

  64. Jenstrup MT, Jaeger P, Lund J, Fomsgaard JS, Bache S, Mathiesen O, Larsen TK, Dahl JB (2012) Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand 56:357–364

    CAS  PubMed  Google Scholar 

  65. Joo JH, Park JW, Kim JS, Kim YH (2011) Is intra-articular multimodal drug injection effective in pain management after total knee arthroplasty? A randomized, double-blinded, prospective study. J Arthroplasty 26:1095–1099

    PubMed  Google Scholar 

  66. Jules- Elysee KM, Wilfred SE, Memtsoudis SG, Kim DH, YaDeau JT, Urban MK, Lichardi ML, McLawhorn AS, Sculco TP (2012) Steroid modulation of cytokine release and desmosine levels in bilateral total knee replacement: a prospective, double-blind, randomized controlled trial. J Bone Joint Surg Am 94:2120–2127

    PubMed  Google Scholar 

  67. Jules-Elysee KM, Lipnitsky JY, Patel N, Anastasian G, Wilfred SE, Urban MK, Sculco TP (2012) Use of low-dose steroids in decreasing cytokine release during bilateral total knee replacement. Reg Anesth Pain Med 36:36–40

    Google Scholar 

  68. Kadic L, Boonstra MC, De Waal Malefijt MC, Lako SJ, Van Egmond J, Driessen JJ (2009) Continuous femoral nerve block after total knee arthroplasty? Acta Anaesthesiol Scand 53:914–920

    CAS  PubMed  Google Scholar 

  69. Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG (2003) Preoperative prediction of severe postoperative pain. Pain 105:415–423

    CAS  PubMed  Google Scholar 

  70. Kawamata M, Watanabe H, Nishikawa K, Takahashi T, Kozuka Y, Kawamata T, Omote K, Namiki A (2002) Different mechanisms of development and maintenance of experimental incision-induced hyperalgesia in human skin. Anesthesiology 97:550–559

    CAS  PubMed  Google Scholar 

  71. Kawasaki Y, Zhang L, Cheng JK, Ji RR (2008) Cytokine mechanisms of central sensitization: distinct and overlapping role of interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha in regulating synaptic and neuronal activity in the superficial spinal cord. J Neurosci 28:5189–5194

    CAS  PubMed Central  PubMed  Google Scholar 

  72. Keefe FJ, Lefebvre JC, Egert JR, Affleck G, Sullivan MJ, Caldwell DS (2000) The relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: the role of catastrophizing. Pain 87:325–334

    CAS  PubMed  Google Scholar 

  73. Kehlet H, Andersen LO (2011) Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice. Acta Anaesthesiol Scand 55:778–784

    PubMed  Google Scholar 

  74. Kehlet H, Dahl JB (1993) The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg 77:1048–1056

    CAS  PubMed  Google Scholar 

  75. Kehlet H, Jensen TS, Woolf CJ (2006) Persistent postsurgical pain: risk factors and prevention. Lancet 367:1618–1625

    PubMed  Google Scholar 

  76. Kerr DR, Kohan L (2008) Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop 79:174–183

    PubMed  Google Scholar 

  77. Khan AA, Iadarola M, Yang HY, Dionne RA (2007) Expression of COX-1 and COX-2 in a clinical model of acute inflammation. J Pain 8:349–354

    CAS  PubMed Central  PubMed  Google Scholar 

  78. Kinghorn K, Ellinas H, Barboi AC, Dolinski SY (2012) Case scenario: nerve injury after knee arthroplasty and sciatic nerve block. Anesthesiology 116:918–923

    PubMed  Google Scholar 

  79. Kosek E, Ordeberg G (2000) Abnormalities of somatosensory perception in patients with painful osteoarthritis normalize following successful treatment. Eur J Pain 4:229–238

    CAS  PubMed  Google Scholar 

  80. Kosek E, Ordeberg G (2000) Lack of pressure pain modulation by heterotopic noxious conditioning stimulation in patients with painful osteoarthritis before, but not following, surgical pain relief. Pain 88:69–78

    CAS  PubMed  Google Scholar 

  81. Krenzel BA, Cook C, Martin GN, Vail TP, Attarian DE, Bolognesi MP (2009) Posterior capsular injections of ropivacaine during total knee arthroplasty: a randomized, double-blind, placebo-controlled study. J Arthroplasty 24:138–143

    PubMed  Google Scholar 

  82. Kuehn BM (2009) New pain guideline for older patients: avoid NSAIDs, consider opioids. JAMA 302:19

    CAS  PubMed  Google Scholar 

  83. Laskowski K, Stirling A, McKay W, Lim HJ (2011) A systematic review of intravenous ketamine for postoperative analgesia. Can J Anaesth 58:911–923

    PubMed  Google Scholar 

  84. Lautenbacher S, Huber C, Kunz M, Parthum A, Weber PG, Griessinger N, Sittl R (2009) Hypervigilance as predictor of postoperative acute pain: its predictive potency compared with experimental pain sensitivity, cortisol reactivity, and affective state. Clin J Pain 25:92–100

    PubMed  Google Scholar 

  85. Lavand’homme P (2011) The progression from acute to chronic pain. Curr Opin Anaesthesiol 24:545–550

    PubMed  Google Scholar 

  86. Liu SS, Buvanendran A, Rathmell JP, Sawhney M, Bae JJ, Moric M, Perros S, Pope AJ, Poultsides L, Della Valle CJ, Shin NS, McCartney CJ, Ma Y, Shah M, Wood MJ, Manion SC, Sculco TP (2012) A cross-sectional survey on prevalence and risk factors for persistent postsurgical pain 1 year after total hip and knee replacement. Reg Anesth Pain Med 37:415–422

    PubMed  Google Scholar 

  87. Lunn TH, Kristensen BB, Andersen LO, Husted H, Otte KS, Gaarn-Larsen L, Kehlet H (2011) Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial. Br J Anaesth 106:230–238

    CAS  PubMed  Google Scholar 

  88. Macalou D, Trueck S, Meuret P, Heck M, Vial F, Ouologuem S, Capdevila X, Virion JM, Bouaziz H (2004) Postoperative analgesia after total knee replacement: the effect of an obturator nerve block added to the femoral 3-in-1 nerve block. Anesth Analg 99:251–254

    CAS  PubMed  Google Scholar 

  89. Macfarlane AJ, Prasad GA, Chan VW, Brull R (2009) Does regional anesthesia improve outcome after total knee arthroplasty? Clin Orthop Relat Res 467:2379–2402

    PubMed Central  PubMed  Google Scholar 

  90. Maheshwari AV, Blum YC, Shekhar L, Ranawat AS, Ranawat CS (2009) Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res 467:1418–1423

    PubMed Central  PubMed  Google Scholar 

  91. Marhofer D, Kettner SC, Marhofer P, Pils S, Weber M, Zeitlinger M (2013) Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: a volunteer study. Br J Anaesth 110:438–442

    CAS  PubMed  Google Scholar 

  92. Marret E, Kurdi O, Zufferey P, Bonnet F (2005) Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects: meta-analysis of randomized controlled trials. Anesthesiology 102:1249–1260

    CAS  PubMed  Google Scholar 

  93. Martin F, Martinez V, Mazoit JX, Bouhassira D, Cherif K, Gentili ME, Piriou P, Chauvin M, Fletcher D (2008) Antiinflammatory effect of peripheral nerve blocks after knee surgery: clinical and biologic evaluation. Anesthesiology 109:484–490

    CAS  PubMed Central  PubMed  Google Scholar 

  94. Matsuura T, Mori T, Hasaka M, Kuno M, Kawawaki J, Nishikawa K, Narahashi T, Sawada M, Asada A (2012) Inhibition of voltage-gated proton channels by local anaesthetics in GMI-R1 rat microglia. J Physiol 590:827–844

    CAS  PubMed Central  PubMed  Google Scholar 

  95. McCartney CJ, McLeod GA (2011) Local infiltration analgesia for total knee arthroplasty. Br J Anaesth 107:487–489

    CAS  PubMed  Google Scholar 

  96. Merskey H (1994) Classification of chronic pain, 2nd edn. IASP Press, Seattle, pp 209–214

    Google Scholar 

  97. Mont MA, Serna FK, Krackow KA, Hungerford DS (1996) Exploration of radiographically normal total knee replacements for unexplained pain. Clin Orthop Relat Res 331:216–220

    PubMed  Google Scholar 

  98. Morze CJ, Johnson NR, Williams G, Moroney M, Lamberton T, McAuliffe M (2013) Knee pain during the first three months after unilateral total knee arthroplasty: a multi-centre prospective cohort study. J Arthroplasty 28:1565–1570

    PubMed  Google Scholar 

  99. Murray DW, Frost SJ (1998) Pain in the assessment of total knee replacement. J Bone Joint Surg Br 80:426–431

    CAS  PubMed  Google Scholar 

  100. Muscara MN, McKnight W, Asfaha S, Wallace JL (2000) Wound collagen deposition in rats: effects of an NO-NSAID and a selective COX-2 inhibitor. Br J Pharmacol 129:681–686

    CAS  PubMed Central  PubMed  Google Scholar 

  101. Nicholson G, Hall GM (2011) Effects of anaesthesia on the inflammatory response to injury. Curr Opin Anaesthesiol 24:370–374

    PubMed  Google Scholar 

  102. Ogata K, Shinohara M, Inoue H, Miyata T, Yoshioka M, Ohura K (1993) Effects of local anesthetics on rat macrophage phagocytosis. Nihon Yakurigaku Zasshi 101:53–58

    CAS  PubMed  Google Scholar 

  103. Ogonda L, Wilson R, Archbold P, Lawlor M, Humphreys P, O’Brien S, Beverland D (2005) A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial. J Bone Joint Surg Am 87:701–710

    PubMed  Google Scholar 

  104. Omoigui S (2007) The biochemical origin of pain—proposing a new law of pain: the origin of all pain is inflammation and the inflammatory response. Part 1 of 3—a unifying law of pain. Med Hypotheses 69:70–82

    CAS  PubMed Central  PubMed  Google Scholar 

  105. Omoigui S (2007) The biochemical origin of pain: the origin of all pain is inflammation and the inflammatory response. Part 2 of 3—inflammatory profile of pain syndromes. Med Hypotheses 69:1169–1178

    CAS  PubMed Central  PubMed  Google Scholar 

  106. Orebaugh SL, Kentor ML, Williams BA (2012) Adverse outcomes associated with nerve stimulator-guided and ultrasound-guided peripheral nerve blocks by supervised trainees: update of a single-site database. Reg Anesth Pain Med 37:577–582

    CAS  PubMed Central  PubMed  Google Scholar 

  107. Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A, Murthy Y (2010) Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology 113:1144–1162

    PubMed  Google Scholar 

  108. Perlas A, Kirkham KR, Billing R, Tse C, Brull R, Gandhi R, Chan VW (2013) The impact of analgesic modality on early ambulation following total knee arthroplasty. Reg Anesth Pain Med 38:334–339

    PubMed  Google Scholar 

  109. Petterson SC, Raisis L, Bodenstab A, Snyder-Mackler L (2007) Disease-specific gender differences among total knee arthroplasty candidates. J Bone Joint Surg Am 89:2327–2333

    CAS  PubMed  Google Scholar 

  110. Pinto PR, McIntyre T, Almeida A, Araujo-Soares V (2012) The mediating role of pain catastrophizing in the relationship between presurgical anxiety and acute postsurgical pain after hysterectomy. Pain 153:218–226

    PubMed  Google Scholar 

  111. Pogatzki-Zahn EM, Zahn PK (2006) From preemptive to preventive analgesia. Curr Opin Anaesthesiol 19:551–555

    PubMed  Google Scholar 

  112. Puolakka PA, Rorarius MG, Roviola M, Puolakka TJ, Nordhausen K, Lindgren L (2010) Persistent pain following knee arthroplasty. Eur J Anaesthesiol 27:455–460

    PubMed  Google Scholar 

  113. Rawal N (2012) Epidural technique for postoperative pain: gold standard no more? Reg Anesth Pain Med 37:310–317

    PubMed  Google Scholar 

  114. Remy C, Marret E, Bonnet F (2005) Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. Br J Anaesth 94:505–513

    CAS  PubMed  Google Scholar 

  115. Richman JM, Liu SS, Courpas G, Wong R, Rowlingson AJ, McGready J, Cohen SR, Wu CL (2006) Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg 102:248–257

    PubMed  Google Scholar 

  116. Roth ML, Tripp DA, Harrison MH, Sullivan M, Carson P (2007) Demographic and psychosocial predictors of acute perioperative pain for total knee arthroplasty. Pain Res Manag 12:185–194

    PubMed Central  PubMed  Google Scholar 

  117. Schnabel A, Meyer-Friessem CH, Zahn PK, Pogatzki-Zahn EM (2013) Ultrasound compared with nerve stimulation guidance for peripheral nerve catheter placement: a meta-analysis of randomized controlled trials. Br J Anaesth 111:564–572

    CAS  PubMed  Google Scholar 

  118. Schug SA (2007) Peripheral nerve blockade carries only a minimal risk of permanent neurological complications. Anaesth Intensive Care 35:11–12

    CAS  PubMed  Google Scholar 

  119. Scott CE, Howie CR, MacDonald D, Biant LC (2010) Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 92:1253–1258

    CAS  PubMed  Google Scholar 

  120. Sean VW, Chin PL, Chia SL, Yang KY, Lo NN, Yeo SJ (2011) Single-dose periarticular steroid infiltration for pain management in total knee arthroplasty: a prospective, double-blind, randomised controlled trial. Singapore Med J 52:19–23

    CAS  PubMed  Google Scholar 

  121. Sharma S, Iorio R, Specht LM, Davies-Lepie S, Healy WL (2010) Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res 468:135–140

    PubMed Central  PubMed  Google Scholar 

  122. Singh JA, Gabriel S, Lewallen D (2008) The impact of gender, age, and preoperative pain severity on pain after TKA. Clin Orthop Relat Res 466:2717–2723

    PubMed Central  PubMed  Google Scholar 

  123. Skou ST, Graven-Nielsen T, Rasmussen S, Simonsen O, Laursen MB, Arendt-Nielsen L (2013) Widespread sensitization in patients with chronic pain after revision total knee arthroplasty. Pain 154:1588–1594

    PubMed  Google Scholar 

  124. Sommer M, de Rijke JM, van Kleef M, Kessels AG, Peters ML, Geurts JW, Patijn J, Gramke HF, Marcus MA (2010) Predictors of acute postoperative pain after elective surgery. Clin J Pain 26:87–94

    PubMed  Google Scholar 

  125. Spreng UJ, Dahl V, Hjall A, Fagerland MW, Raeder J (2010) High-volume local infiltration analgesia combined with intravenous or local ketorolac + morphine compared with epidural analgesia after total knee arthroplasty. Br J Anaesth 105:675–682

    CAS  PubMed  Google Scholar 

  126. Srikandarajah S, Gilron I (2011) Systematic review of movement-evoked pain versus pain at rest in postsurgical clinical trials and meta-analyses: a fundamental distinction requiring standardized measurement. Pain 152:1734–1739

    PubMed  Google Scholar 

  127. Steyaert A, Lavand’homme P (2013) Postoperative opioids: let us take responsibility for the possible consequences. Eur J Anaesthesiol 30:50–52

    PubMed  Google Scholar 

  128. Straube S, Derry S, McQuay HJ, Moore RA (2005) Effect of preoperative Cox-II-selective NSAIDs (coxibs) on postoperative outcomes: a systematic review of randomized studies. Acta Anaesthesiol Scand 49:601–613

    CAS  PubMed  Google Scholar 

  129. Suokas AK, Walsh DA, McWilliams DF, Condon L, Moreton B, Wylde V, Arendt-Nielsen L, Zhang W (2012) Quantitative sensory testing in painful osteoarthritis: a systematic review and meta-analysis. Osteoarthr Cartil 20:1075–1085

    CAS  PubMed  Google Scholar 

  130. Thienpont E (2012) Faster quadriceps recovery with the far medial subvastus approach in minimally invasive total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21:2370–2374

    PubMed  Google Scholar 

  131. Thienpont E (2012) Faster recovery after minimally invasive surgery in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21:2412–2417

    PubMed  Google Scholar 

  132. Thomas T, Robinson C, Champion D, McKell M, Pell M (1998) Prediction and assessment of the severity of post-operative pain and of satisfaction with management. Pain 75:177–185

    CAS  PubMed  Google Scholar 

  133. Torrance N, Smith BH, Bennett MI, Lee AJ (2006) The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J Pain 7:281–289

    PubMed  Google Scholar 

  134. Turan A, Sessler DI (2011) Steroids to ameliorate postoperative pain. Anesthesiology 115:457–459

    PubMed  Google Scholar 

  135. Vilardo L, Shah M (2011) Chronic pain after hip and knee replacement. Tech Reg Anesth Pain Manag 15:110–115

    Google Scholar 

  136. Vissers MM, Bussmann JB, Verhaar JA, Busschbach JJ, Bierma-Zeinstra SM, Reijman M (2012) Psychological factors affecting the outcome of total hip and knee arthroplasty: a systematic review. Semin Arthritis Rheum 41:576–588

    PubMed  Google Scholar 

  137. Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS (2013) Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth 110:191–200

    CAS  PubMed Central  PubMed  Google Scholar 

  138. Wegener JT, van Ooij B, van Dijk CN, Hollmann MW, Preckel B, Stevens MF (2011) Value of single-injection or continuous sciatic nerve block in addition to a continuous femoral nerve block in patients undergoing total knee arthroplasty: a prospective, randomized, controlled trial. Reg Anesth Pain Med 36:481–488

    PubMed  Google Scholar 

  139. Widmer B, Lustig S, Scholes CJ, Molloy A, Leo SP, Coolican MR, Parker DA (2013) Incidence and severity of complications due to femoral nerve blocks performed for knee surgery. Knee 20:181–185

    PubMed  Google Scholar 

  140. Woolf CJ (2011) Central sensitization: implications for the diagnosis and treatment of pain. Pain 152:12–15

    Google Scholar 

  141. Wylde V, Gooberman-Hill R, Horwood J, Beswick A, Noble S, Brookes S, Smith AJ, Pyke M, Dieppe P, Blom AW (2011) The effect of local anaesthetic wound infiltration on chronic pain after lower limb joint replacement: a protocol for a double-blind randomised controlled trial. BMC Musculoskelet Disord 12:53

    PubMed Central  PubMed  Google Scholar 

  142. Wylde V, Hewlett S, Learmonth ID, Dieppe P (2011) Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain 152:566–572

    PubMed  Google Scholar 

  143. Wylde V, Rooker J, Halliday L, Blom A (2011) Acute postoperative pain at rest after hip and knee arthroplasty: severity, sensory qualities and impact on sleep. Orthop Traumatol Surg Res 97:139–144

    CAS  PubMed  Google Scholar 

  144. Xu J, Brennan TJ (2011) The pathophysiology of acute pain: animal models. Curr Opin Anaesthesiol 24:508–514

    PubMed Central  PubMed  Google Scholar 

  145. Yarnitsky D (2010) Conditioned pain modulation (the diffuse noxious inhibitory control-like effect): its relevance for acute and chronic pain states. Curr Opin Anaesthesiol 23:611–615

    PubMed  Google Scholar 

  146. Zhang J, Ho KY, Wang Y (2011) Efficacy of pregabalin in acute postoperative pain: a meta-analysis. Br J Anaesth 106:454–462

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Cliniques Universitaires Saint Luc, Av. Hippocrate 10, 1200, Brussels, Belgium

    Irina Grosu & Patricia Lavand’homme

  2. Department of Orthopaedic Surgery, Cliniques Universitaires Saint Luc, Av. Hippocrate 10, 1200, Brussels, Belgium

    Emmanuel Thienpont

Authors
  1. Irina Grosu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patricia Lavand’homme
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emmanuel Thienpont
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emmanuel Thienpont.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grosu, I., Lavand’homme, P. & Thienpont, E. Pain after knee arthroplasty: an unresolved issue. Knee Surg Sports Traumatol Arthrosc 22, 1744–1758 (2014). https://doi.org/10.1007/s00167-013-2750-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-013-2750-2

Keywords

Search

Navigation