Many Patients With Persistent Pain 1 Year After TKA Report Improvement by 5 to 7 Years: A Mixed-methods Study

• Published in: Clinical orthopaedics and related research 2022-11, Vol.480 (11), p.2075-2088
• Main Authors: Sellevold, Vibeke Bull, Steindal, Simen A., Lindberg, Maren Falch, Småstuen, Milada Cvancarova, Aamodt, Arild, Lerdal, Anners, Dihle, Alfhild
• Format: Article
• Language: English
• Subjects: Aged; Arthroplasty, Replacement, Knee; Comorbidity; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Middle Aged; Mixed methods research; Osteoarthritis; Pain; Pain, Postoperative - diagnosis; Pain, Postoperative - etiology; Patients; Quality of Life; Recovery of Function; Rehabilitation; Statistical analysis; Surgery
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1097/CORR.0000000000002183

Approximately 20% of patients report pain 12 months after TKA. No studies have investigated patients' experiences of living with persistent postsurgical pain 5 to 7 years after TKA by combining a qualitative and quantitative methodology. In a mixed-methods study, we explored patients' experiences of living with persistent pain up to 7 years after primary TKA. We asked: In a subgroup analysis of patients who reported persistent pain 1 year after TKA surgery, how do patients live with persistent pain at the 5- to 7-year postoperative timepoint? This follow-up study was part of a longitudinal study of pain, symptoms, and health-related quality of life in patients who underwent TKA for osteoarthritis. The present study targeted a subgroup of patients (22% [45 of 202]) identified in the longitudinal study who reported no improvement in pain interference with walking at 12 months after surgery. Inclusion criteria were: all 31 patients in this subgroup who attended their 5-year follow-up at the hospital and lived within a 2-hour drive from the hospital. Eight patients declined or were unable to participate due to illness or death. Hence, the final sample consisted of 23 patients (13 women and 10 men). The participants' mean age at surgery was 66 ± 10 years. There were no differences in sociodemographic baseline data between the 23 included and the 22 excluded participants. A mixed-methods approach was employed, in which the quantitative data were followed up and investigated with qualitative interviews. Instruments used were the Brief Pain Inventory preoperatively, 12 months, and 5 years after surgery, as well as a semistructured interview guide. The individual interviews were conducted at one timepoint 5 to 7 years postsurgery to capture how pain was experienced at that timepoint. The interviews were audiorecorded, transcribed, and analyzed using qualitative content analysis. Meaning units were identified, condensed, and sorted into subthemes that were interpreted and abstracted into themes, guided by the research question. With a small sample, the quantitative analysis focused on descriptive statistics and nonparametric statistics when comparing demographics of included and nonincluded patients. In addition, two multivariate mixed models for repeated measures were employed to estimate within-patient and between-patient variations as well as to assess the effect of time on the pain outcomes. Pain with walking decreased from 12 months to 5 years postoperatively (