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Total knee replacement: Is it really an effective procedure for all?

Wylde, Vicky; Dieppe, Paul; Hewlett, Sarah; Learmonth, Ian

Authors

Vicky Wylde

Paul Dieppe

Ian Learmonth



Abstract

Total knee replacement (TKR) is considered an effective intervention for the treatment of chronic knee pain and disability. Yet there is increasing evidence, based on research using patient-based outcome measures, that a significant proportion of patients experience chronic knee pain, functional disability, a poor quality of life and dissatisfaction after TKR. Although some poor outcomes after TKR are due to surgical technique and implant factors, much of the pain and disability after surgery is medically unexplained. A range of possible patient factors could contribute to a poor outcome after TKR. Socio-demographic factors that have been found to correlate with a poor outcome after TKR include female gender, older age and low socio-economical status. Medical factors that are highly predictive of pain and disability after TKR are a greater number of co-morbidities and a worse pre-operative status. A range of psychological factors could be predictive of a poor outcome after surgery including depression, low self-efficacy, poor pain coping strategies, somatization, low social support and patient expectations. It is also proposed that a biological explanation for continuing pain after TKR could involve central sensitisation, a dysfunction of pain modulation by the central nervous system. To improve patient selection for TKR, future research needs to focus on developing a pre-operative screening protocol to identify those patients at risk of medically unexplained pain and disability after TKR. © 2007 Elsevier B.V. All rights reserved.

Citation

Wylde, V., Dieppe, P., Hewlett, S., & Learmonth, I. (2007). Total knee replacement: Is it really an effective procedure for all?. Knee, 14(6), 417-423. https://doi.org/10.1016/j.knee.2007.06.001

Journal Article Type Review
Publication Date Dec 1, 2007
Journal Knee
Print ISSN 0968-0160
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 14
Issue 6
Pages 417-423
DOI https://doi.org/10.1016/j.knee.2007.06.001
Keywords total knee replacement, outcomes assessment, chronic pain, disability
Public URL https://uwe-repository.worktribe.com/output/1023561
Publisher URL http://dx.doi.org/10.1016/j.knee.2007.06.001