Mapping the course to recovery: a prospective study on the anatomic distribution of early postoperative pain after total knee arthroplasty

Kevin L Mekkawy; Bo Zhang; Alyssa Wenzel; Andrew B Harris; Harpal S Khanuja; Robert S Sterling; Vishal Hegde; Julius K Oni

doi:10.1186/s42836-023-00194-3

Mapping the course to recovery: a prospective study on the anatomic distribution of early postoperative pain after total knee arthroplasty

Arthroplasty. 2023 Aug 3;5(1):37. doi: 10.1186/s42836-023-00194-3.

Authors

Kevin L Mekkawy¹, Bo Zhang², Alyssa Wenzel², Andrew B Harris², Harpal S Khanuja², Robert S Sterling², Vishal Hegde², Julius K Oni²

Affiliations

¹ Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA. [email protected].
² Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA.

Abstract

Introduction: Early postoperative pain following total knee arthroplasty significantly impacts outcomes and patient satisfaction. However, the characteristics and sources of early pain after total knee arthroplasty remain unclear. Therefore, the purpose of this study was to determine the anatomic distribution and course of postoperative pain in the acute and subacute period following total knee arthroplasty.

Methods: A prospective observational study of primary, elective unilateral total knee arthroplasty cases was conducted at our academic tertiary care medical center from January 2021 to September 2021. Preoperative variables were extracted from institutional electronic medical records. Postoperatively, patients utilized a knee pain map to identify the two locations with the most significant pain and rated it using the visual analog scale (VAS). The data were collected on day 0, at 2 weeks, 2 months, and 6 months after operation.

Results: This study included 112 patients, with 6% of patients having no pain at postoperative day 0, 22% at 2 weeks, 46% at 2 months, and 86% at 6 months after operation. In those who reported pain, the VAS score (mean ± standard deviation) was 5.8 ± 2.4 on postoperative day 0 and decreased at each follow-up time point (5.4 ± 2.3 at 2 weeks, 3.9 ± 2.2 at 2 months, and 3.8 ± 2.7 at 6 months). The majority of patients were able to identify distinct loci of pain. The most common early pain loci were patellae, thigh, and medial joint line, and this distribution dissipated by 6 months.

Conclusion: At 2 postoperative weeks, pain was primarily at the medial joint, and at 6 months postoperatively, pain was more likely to be at the lateral joint. No relationship was found between pain at six months and pain scores or location at postoperative day 0 or 2 weeks. Understanding the distribution and progression of knee pain following total knee arthroplasty may benefit patient education and targeted interventions.

Level of evidence: Level II, prospective observational study.

Keywords: Pain location; Pain mapping; Postoperative pain; Total knee arthroplasty.