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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 30-09-2023 | Knee-TEP | KNEE

Less pain reported 5 years after cementless compared to cemented unicompartmental knee replacement: an analysis of pain, neuropathy, and co-morbidity scores

Authors: Azmi Rahman, Benjamin Martin, Cathy Jenkins, Hasan Mohammad, Karen Barker, Christopher Dodd, William Jackson, Andrew Price, Stephen Mellon, David W Murray

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2023

Abstract

Purpose

To compare patient-reported pain scores and assess the influence of neuropathy and co-morbidity, on knee pain following cemented and cementless medial unicompartmental knee replacement (UKR) 5 years after surgery.

Method

In this longitudinal study, 262 cemented and 262 cementless Oxford UKR performed for the same indications and with the same techniques were recruited. Patients were reviewed at five years, evaluating patient-reported pain and association with clinical outcomes. Intermittent and Constant Osteoarthritis Pain (ICOAP), PainDETECT (PD), Charnley score, Oxford Knee Score (OKS) and American Knee Society Score (AKSS) were compared.

Results

In both cohorts, intermittent pain was more common than constant pain (47% vs 21%). Cementless knees reported significantly less pain than cemented (ICOAP-Total 5/100 vs 11/100, p < 0.0001). A greater proportion of cementless knees experienced no pain at all (ICOAP = 0/100, 61% vs 43%, p < 0.0001) and 75% fewer experienced severe or extreme pain. Pain sub-scores in PD, OKS and AKSS follow this trend. Pain was unlikely to be neuropathic (PD positive: 5.26%), but patients reporting high levels of ‘strongest’ pain were three times more likely to be neuropathic. Patients with co-morbidities (Charnley C) experienced greater pain than those without (Charnley A+B) across all knee-specific scores, despite scores being knee specific.

Conclusion

Both cemented and cementless UKR in this study had substantially less pain than that reported in literature following TKR. Cementless UKR had significantly less pain than cemented UKR in all scores. Two-thirds of patients with a cementless UKR had no pain at all at 5 years, and pain experienced was most likely to be mild and intermittent with no patients in severe or extreme pain. Patients with cementless UKR that had higher levels of pain were more likely to have co-morbidity or evidence or neuropathic pain. It is unclear why cementless UKR have less pain than cemented; further study is necessary.

Oxford®Partial Knee Microplasty® Instrumentation Surgical Technique. Bridgend, UK: Zimmer Biomet; 2019.

Ben-Shlomo Y, Blom A, Boulton C, Brittain R, Clark E, Dawson-Bowling S, et al. National Joint Registry Annual Reports. The National Joint Registry 19th Annual Report 2022. London: National Joint Registry; 2022.

Burn E, Sanchez-Santos MT, Pandit HG, Hamilton TW, Liddle AD, Murray DW et al (2018) Ten-year patient-reported outcomes following total and minimally invasive unicompartmental knee arthroplasty: a propensity score-matched cohort analysis. Knee Surg Sports Traumatol Arthrosc 26:1455–1464CrossRefPubMed

Davis AM, Lohmander LS, Wong R, Venkataramanan V, Hawker GA (2010) Evaluating the responsiveness of the ICOAP following hip or knee replacement. Osteoarthritis Cartilage 18:1043–1045CrossRefPubMed

Dunbar MJ, Robertsson O, Ryd L (2004) What’s all that noise? The effect of co-morbidity on health outcome questionnaire results after knee arthroplasty. Acta Orthop Scand 75:119–126CrossRefPubMed

Freynhagen R, Baron R, Gockel U, Tölle TR (2006) painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 22:1911–1920CrossRefPubMed

Gulati A, Chau R, Pandit HG, Gray H, Price AJ, Dodd CA et al (2009) The incidence of physiological radiolucency following Oxford unicompartmental knee replacement and its relationship to outcome. J Bone Joint Surg Br 91:896–902CrossRefPubMed

Hamilton TW, Rizkalla JM, Kontochristos L, Marks BE, Mellon SJ, Dodd CAF et al (2017) The interaction of caseload and usage in determining outcomes of unicompartmental knee arthroplasty: a meta-analysis. J Arthroplasty 32:3228-3237.e3222CrossRefPubMed

Harris K, Dawson J, Doll H, Field RE, Murray DW, Fitzpatrick R et al (2013) Can pain and function be distinguished in the Oxford Knee Score in a meaningful way? An exploratory and confirmatory factor analysis. Qual Life Res 22:2561–2568CrossRefPubMed

10.

Hunter DJ, McDougall JJ, Keefe FJ (2008) The symptoms of osteoarthritis and the genesis of pain. Rheum Dis Clin North Am 34:623–643CrossRefPubMedPubMedCentral

11.

Insall JN, Dorr LD, Scott RD, Norman WS (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14CrossRef

12.

Jones G, Kotti M, Wiik A, Collins R, Brevadt M, Strachan R et al (2016) Gait comparison of unicompartmental and total knee arthroplasties with healthy controls. Bone Joint J 98-B:16–21CrossRefPubMedPubMedCentral

13.

Kendrick BJ, Kaptein BL, Valstar ER, Gill HS, Jackson WF, Dodd CA et al (2015) Cemented versus cementless Oxford unicompartmental knee arthroplasty using radiostereometric analysis: a randomised controlled trial. Bone Joint J 97-b:185–191CrossRefPubMed

14.

15.

Kessler SG, Grammozis A, Günther K-P, Kirschner S (2011) Test-theoretical review of the German version of the Intermittent and Constant Osteoarthritis Pain Score (ICOAP) - a questionnaire for pain assessment in patients with gonarthrosis. Z Orthop Unfall 149:22–26CrossRefPubMed

16.

Liddle A, Pandit H, Judge A, Murray D (2015) Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14,076 matched patients from the National Joint Registry for England and Wales. Bone Joint J 97-B:793–801CrossRefPubMed

17.

Martin B, Rahman A, Jenkins C, Mohammad H, Barker K, Dodd C et al (2022) Comparison of five-year clinical outcomes of 524 cemented and cementless medial unicompartmental knee replacements. Knee 34:89–97CrossRefPubMed

18.

Mathis DT, Hauser A, Iordache E, Amsler F, Hirschmann MT (2021) Typical pain patterns in unhappy patients after total knee arthroplasty. J Arthroplasty 36:1947–1957CrossRefPubMed

19.

Mehta SP, Sankar A, Venkataramanan V, Lohmander LS, Katz JN, Hawker GA et al (2016) Cross-cultural validation of the ICOAP and physical function short forms of the HOOS and KOOS in a multi-country study of patients with hip and knee osteoarthritis. Osteoarthritis Cartilage 24:2077–2081CrossRefPubMed

20.

Mohammad HR, Bullock GS, Kennedy JA, Mellon SJ, Murray D, Judge A (2021) Cementless unicompartmental knee replacement achieves better ten-year clinical outcomes than cemented: a systematic review. Knee Surg Sports Traumatol Arthrosc 29:3229–3245CrossRefPubMed

21.

Mohammad HR, Kennedy JA, Mellon SJ, Judge A, Dodd CA, Murray DW (2019) Ten-year clinical and radiographic results of 1000 cementless Oxford unicompartmental knee replacements. Knee Surg Sports Traumatol Arthrosc 28:1479–1487CrossRefPubMedPubMedCentral

22.

Moreton BJ, Wheeler M, Walsh DA, Lincoln NB (2012) Rasch analysis of the intermittent and constant osteoarthritis pain (ICOAP) scale. Osteoarthritis Cartilage 20:1109–1115CrossRefPubMedPubMedCentral

23.

Pandit H, Jenkins C, Beard DJ, Gallagher J, Price AJ, Dodd CA et al (2009) Cementless Oxford unicompartmental knee replacement shows reduced radiolucency at one year. J Bone Joint Surg Br 91:185–189CrossRefPubMed

24.

Pandit H, Liddle AD, Kendrick BJ, Jenkins C, Price AJ, Gill HS et al (2013) Improved fixation in cementless unicompartmental knee replacement: five-year results of a randomized controlled trial. J Bone Joint Surg Am 95:1365–1372CrossRefPubMed

25.

Rahman A, Omoregie G, Mellon S, Murray D. Fixation of the tibial wall in unicompartmental knee replacement. Paper presented at: BASK2021.

26.

Robbins SM, Rastogi R, Howard J, Rosedale R (2014) Comparison of measurement properties of the P4 pain scale and disease specific pain measures in patients with knee osteoarthritis. Osteoarthritis Cartilage 22:805–812CrossRefPubMed

27.

Rothwell AG, Hooper GJ, Hobbs A, Frampton CM (2010) An analysis of the Oxford hip and knee scores and their relationship to early joint revision in the New Zealand joint registry. J Bone Joint Surg Br 92:413–418CrossRefPubMed

28.

Simpson DJ, Kendrick BJL, Dodd CAF, Price AJ, Gill HS, Murray DW (2011) Load transfer in the proximal tibia following implantation with a unicompartmental knee replacement:a static snapshot. Proc Inst Mech Eng H 225:521–529CrossRefPubMed

29.

Singh JA, Luo R, Landon GC, Suarez-Almazor M (2014) Reliability and clinically important improvement thresholds for osteoarthritis pain and function scales: a multicenter study. J Rheumatol 41:509–515CrossRefPubMedPubMedCentral

30.

Wandel S, Jüni P, Tendal B, Nüesch E, Villiger PM, Welton NJ et al (2010) Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ 341:c4675CrossRefPubMedPubMedCentral

Title: Less pain reported 5 years after cementless compared to cemented unicompartmental knee replacement: an analysis of pain, neuropathy, and co-morbidity scores
Authors: Azmi Rahman
Benjamin Martin
Cathy Jenkins
Hasan Mohammad
Karen Barker
Christopher Dodd
William Jackson
Andrew Price
Stephen Mellon
David W Murray
Publication date: 30-09-2023
Publisher: Springer Berlin Heidelberg
Keywords: Knee-TEP
Knee-TEP
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07589-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Less pain reported 5 years after cementless compared to cemented unicompartmental knee replacement: an analysis of pain, neuropathy, and co-morbidity scores

Abstract

Purpose

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Method

Results

Conclusion

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