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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 Article: PDF Only

Objectives: While the majority of patients undergoing Total Knee Arthroplasty report substantial improvement in pain and function, a significant subset experience persistent post-surgical 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 six month 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 (ROM) 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, while 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.

*University of Iowa, Carver College of Medicine, Department of Anesthesia, Iowa City, IA

University of Iowa, College of Public Health, Department of Biostatistics, Iowa City, IA

University of Iowa, College of Nursing, Iowa City, IA

§University of Iowa, Carver College of Medicine, Department of Physical Therapy and Rehabilitation Science, Iowa City, IA

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

This work was funded by: The National Institutes of Nursing Research (R01 NR009844), the University Of Iowa College Of Nursing, and DJO, Inc. Dr. Sluka serves as a consultant for DJO, Inc. There are no other conflicts of interest to report.

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

Received November 15, 2016

Accepted July 10, 2017

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