Total knee arthroplasty postsurgical chronic pain, neuropathic pain, and the prevalence of neuropathic symptoms: A prospective observational study in Turkey

Abstract

Purpose: Chronic post-surgical pain (CPSP) is a detrimental condition that persists at least two months after surgical procedures and seriously affects patients’ quality of life. Although its incidence varies according to operation types and definitions, its prevalence is between 3% and 85%. The purpose of this study is to evaluate the prevalence of CPSP and neuro-pathic pain in patients undergoing TKA for osteoarthritis. Patients and Methods: In this study, patients who had undergone total knee arthroplasty (TKA) were examined prospectively and observationally. 42 patients were included in the study. Numeric rate scale (NRS) for developing chronic pain, Douleur Neuropathique 4 (DN-4) questionnaire to evaluate neuropathic pain and symptoms, and von Frey filaments to evaluate mechanical hyperesthesia and alladony. Results: NRS scores were 1 or higher for all patients. Twenty-seven patients constituted the mild pain group (NRS: 1–4), and 15 patients constituted the moderate pain group (NRS: 4–7). The number of patients defined as having “neuropathic pain,” according to DN-4 scores, was 17 (40.4%; DN-4 ≥ 4). The moderate pain group reported greater severity of neuropathic symptoms on average than the mild pain group (p = 0.039). When patients knees affected by TKA were divided into suprapatellar, patellar, and infrapatellar regions and evaluated with von Frey filaments, a significant difference was found between the three regions (p < 0.05). Conclusion: In this study, we showed—unlike other studies—that the rate of neuropathic pain was higher among CPSP patients, and all patients had neuropathic symptoms. In evaluating patients knees with von Frey filaments, we showed that the neuropathic compo-nent of patients’ pain occurred mostly in the knee’s infrapatellar region. Although the incidence of CPSP and neuropathic pain in these patients was higher than expected, we think CPSP, its diagnosis, and its treatment present an important issue that requires further examination.