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Longitudinal Postoperative Course of Pain and Dysfunction Following Total Knee Arthroplasty

Hadlandsmyth, Katherine, PhD*; Zimmerman, M.Bridget, PhD; Wajid, Roohina, BS; Sluka, Kathleen, A., PT, PhD§; Herr, Keela, PHD, RN, FAAN, AGSF; Clark, Charles, R., MD; Noiseux, Nicolas, O., MD; Callaghan, John, J., MD; Rakel, Barbara, A., PhD, RN, FAAN

doi: 10.1097/AJP.0000000000000540
Original Articles

Objectives: Although the majority of patients undergoing total knee arthroplasty (TKA) report substantial improvement in pain and function, a significant subset experience persistent postsurgical pain and dysfunction. Better understanding of the longitudinal postoperative course is needed, including the association between patient status following physical rehabilitation at 6-weeks post-TKA, to 6-months outcomes. This study aims to described the postoperative course of TKA and examine variables associated with change in pain and functioning between 6-weeks and 6-months post-TKA.

Methods: In this longitudinal study of 223 participants, assessments of analgesic intake, depression, anxiety, pain catastrophizing, dysfunction, resting and range of motion pain, and pain sensitivity were completed at 6-weeks post-TKA. Analgesic intake, pain ratings, and dysfunction data were also collected at 6-months post-TKA. Pain and dysfunction ratings were divided into none-mild and moderate-severe categories.

Results: Between 6-weeks and 6-months post-TKA, 75% of the sample stayed in the same pain category, 20% improved, and 5% worsened. In terms of functional changes between 6 weeks and 6 months, 65% of the sample stayed in the same functional category, whereas 31% improved and 5% worsened.

Discussion: These findings demonstrate that the majority of patients’ pain and functioning remains stable between 6 weeks and 6 months post-TKA. However, a notable subset continues to improve or worsen in pain and functioning and the current study identifies variables associated with these changes.

*Department of Anesthesia, Carver College of Medicine

Department of Biostatistics, College of Public Health

College of Nursing

Departments of §Physical Therapy and Rehabilitation Science

Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA

Funded by The National Institutes of Nursing Research (R01 NR009844), the University of Iowa College of Nursing Iowa City, IA, and DJO Inc. K.A.S. serves as a consultant for DJO Inc. The remaining authors declare no conflict of interest.

Reprints: Katherine Hadlandsmyth, PhD, Department of Anesthesia, University of Iowa Hospitals and Clinics, 8476 JCP, 200 Hawkins Drive, Iowa City, IA 52242 (e-mail:

Received November 15, 2016

Received in revised form May 30, 2017

Accepted July 10, 2017

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