Persistent Postoperative Pain and Joint Stiffness After Total Knee Arthroplasty Performed for Osteoarthritis

Persistent Postoperative Pain and Joint Stiffness After Total Knee Arthroplasty Performed for Osteoarthritis

Persistent pain and joint stiffness after surgery may interfere with recovery and adversely affect quality of life in up to 40% of patients who have undergone total knee arthroplasty. There is growing evidence that inflammation as well as other medical and psychological factors may be associated with osteoarthritis severity, progression, and associated pain severity. This study aims to identify clinical, biological, and psychological factors that contribute to and predict the development of these complications. Identification of such factors may allow us to target preventative measures to the patients at highest risk of persistent postoperative pain and joint stiffness.

Inclusion Criteria:

• Elective primary unilateral total knee arthroplasty
• Osteoarthritis with radiologic evidence of "severe narrowing" and/or "bone on bone" in the affected joint
• Patients of surgeons who have agreed to participate in the study
• Age > 18 years
• American Society of Anesthesiologists (ASA) Physical Status 1-3
• Regional anesthesia
• Epidural patient-controlled analgesia (PCA) for postoperative pain
• Adductor canal block for postoperative pain

Exclusion Criteria:

• Contraindication to regional anesthesia, NSAIDs, dexamethasone or acetaminophen
• Use of general anesthesia
• History of >6 weeks of daily opioid use and/or any use of non-prescribed opioids
• Preoperative oral steroid use in the past 6 months
• Intra-articular steroid injection within one month of scheduled surgery in affected joint
• Non-English speakers
• Pre-existing diagnosis of rheumatic disease or autoimmune disease (e.g. rheumatoid arthritis, psoriatic arthritis, inflammatory bowel disease, multiple sclerosis, Type I diabetes)
• Peri-articular injections or infusions for postoperative pain
• Diagnosis of crystalline arthropathy
• Diagnosis of osteonecrosis
• Active infection or use of antibiotics
• Pregnant women