Authors: Manjot Singh, Joyce Harary, Peter Schilling, Wayne E. Moschetti
Abstract
Introduction
Severe knee osteoarthritis (OA) is a painful and disabling condition that is commonly managed with total knee arthroplasty (TKA). However, since patients frequently present with bilateral OA, their decision to proceed with subsequent TKA may be based on a different severity of pain after having previously undergone TKA.
Methods
In this retrospective review, patients who underwent unilateral or bilateral TKA between November 2018 to December 2023 and used a web-based home therapy program (Force Therapeutics) were included. Daily Visual Analog Scale (VAS) pain scores (0-10) were followed from 30 days preoperatively to 90 days postoperatively across all patients and across first and second TKA patients. Mean pre-/post-operative plateaus in pain scores were described and compared across all cohorts.
Results
Among 2,273 included patients, mean age was 68.9 years, 56.1% were female, and mean body mass index was 31.7kg/m2. Most patients (97.8%) underwent a unilateral procedure, though 12.6% of them had both knees replaced over the study period. The mean preoperative (-30 to 0 days) plateau pain score was 5.6 (SD=0.1) while the mean postoperative (64 to 90 days) plateau pain score was 2.1 (SD=0.2), which was significantly improved from baseline. Among the 280 patients who had both knees replaced, mean time between surgeries was 329 (SD=310) days. The mean preoperative plateau pain score was significantly lower (First Surgery=5.7 vs Second Surgery=4.7, p<0.001) while the mean postoperative plateau pain score was significantly higher (1.9 vs 2.4, p<0.001) among second TKA patients.
Conclusions
Following TKA, pain scores improved significantly for all patients. Patients with bilateral knee OA, in particular, undergo their second contralateral TKA with lower preoperative and higher postoperative patient-reported pain scores than their first TKA.
