-- Randy Dotinga
THURSDAY, March 13, 2014 (HealthDay News) -- Women with certain
kinds of arthritis are among groups of patients who are most
vulnerable to serious pain after undergoing knee replacement
surgery, a new study finds.
General anesthesia and longer time in a tourniquet also appear
to contribute to higher levels of pain, the study authors said.
"There is no question that pain after total knee replacement is greater than that after total hip replacement," Dr. Thomas Sculco, surgeon-in-chief at New York City's Hospital for Special Surgery, said in a hospital news release. "Many factors play a role, and our studies found that younger female patients, particularly those with post-traumatic or rheumatoid arthritis, had the highest pain scores."
Sculco and his colleagues examined the medical records of 273
patients who underwent total knee replacement procedures from 2007
Those who suffered the most pain during rest after surgery
included: women; people aged 45 to 65; those with osteoarthritis,
rheumatoid arthritis or arthritis from an injury; people who were
obese; and those who had more pain when they were admitted to the
hospital. But those with avascular necrosis, a disease that causes
parts of bones to die, had significantly lower levels of pain, the
study authors noted.
When the patients were involved in physical activity, those who
were aged 45 to 65, who were obese, or who had suffered from more
pain upon hospital admission had the highest levels of pain after
surgery. Those with osteoarthritis or avascular necrosis, or both
conditions, had lower levels of pain related to physical activity,
the findings indicated.
"Before patients come in to the hospital, surgeons should have a thorough discussion with them regarding postoperative pain, particularly in the groups that we found tended to have more pain," Sculco said. "More aggressive pain management techniques may be necessary for these patients."
In another study of knee replacement surgery, the researchers
looked at the same medical records and determined that pain was
higher among people at rest who had received general anesthesia
(instead of an epidural or spinal block), those who were in a
tourniquet for a longer period of time, those with more blood loss,
and those with large kneecaps.
"The surgeon must be aware not to use an implant that is too large for the knee or a kneecap component that is excessive in size. In addition, the location of the joint line must be accurately positioned after the knee replacement, for if it is too high it may lead to increased pain," Sculco pointed out in the news release.
The research was scheduled to be presented March 11 at the
annual meeting of the American Academy of Orthopaedic Surgeons, in
New Orleans. Research presented at medical meetings should be
viewed as preliminary until published in a peer-reviewed
For more about knee replacement surgery, visit the
U.S. National Library of Medicine.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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