» Articles » PMID: 36556954

Central Sensitization Is Associated with Inferior Patient-Reported Outcomes and Increased Osteotomy Site Pain in Patients Undergoing Medial Opening-Wedge High Tibial Osteotomy

Overview
Publisher MDPI
Specialty General Medicine
Date 2022 Dec 23
PMID 36556954
Authors
Affiliations
Soon will be listed here.
Abstract

Background and Objectives: Studies have shown that centrally sensitized patients have worse clinical outcomes following total knee arthroplasty (TKA) than non-centrally sensitized patients. It is unclear whether central sensitization (CS) affects patient-reported outcomes (PROs) and/or level of osteotomy site pain in patients undergoing medial opening-wedge high tibial osteotomy (MOWHTO). The purpose of this study was to determine whether CS is associated with PROs and osteotomy site pain following MOWHTO. Materials and Methods: A retrospective evaluation was conducted on 140 patients with varus knee osteoarthritis (OA) who were treated with MOWHTO and monitored for two years. Before surgery, the Central Sensitization Inventory (CSI) was used to assess CS status, and a CSI of 40 or higher was considered indicative of CS. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and pain visual analogue scale (VAS) were used to assess PROs. The minimal clinically important difference (MCID) for the WOMAC was set as 4.2 for the pain subscore, 1.9 for the stiffness subscore, 10.1 for the function subscore, and 16.1 for the total based on the results of a previous study. The WOMAC score, pain VAS score of the osteotomy site, and the achievement rates of WOMAC MCID were compared between the CS and non-CS groups. Results: Thirty-seven patients were assigned to the CS group, whereas 84 were assigned to the non-CS group. Before surgery, the CS group showed a higher WOMAC score than the non-CS group (58.7 vs. 49.4, p < 0.05). While there was a statistically significant improvement in WOMAC subscores (pain, stiffness, function, and total) for both groups at two years after surgery (all p < 0.05), the CS group had a higher WOMAC score than the non-CS group (37.1 vs. 21.8, p < 0.05). The CS group showed significantly inferior results in pre- and postoperative changes of WOMAC subscores (pain, function, and total) relative to the non-CS group (all p < 0.05). In addition, pain at the osteotomy site was more severe in the CS group than in the non-CS group at two years after surgery (4.8 vs. 2.2, p < 0.05). Patients with CS had worse MCID achievement rates across the board for WOMAC pain, function, and total scores (all p < 0.05) compared to the non-CS group. Conclusions: Centrally sensitized patients following MOWHTO had worse PROs and more severe osteotomy site pain compared to non-centrally sensitized patients. Furthermore, the WOMAC MCID achievement rate of patients with CS was lower than that of patients without CS. Therefore, appropriate preoperative counseling and perioperative pain management are necessary for patients with CS undergoing MOWHTO. Level of Evidence: Level III, case-control study.

Citing Articles

Factors associated with pain and functional impairment five years after total knee arthroplasty: a prospective observational study.

Olsen U, Sellevold V, Gay C, Aamodt A, Lerdal A, Hagen M BMC Musculoskelet Disord. 2024; 25(1):22.

PMID: 38167008 PMC: 10759478. DOI: 10.1186/s12891-023-07125-y.


Low central sensitisation inventory score is associated with better post-operative outcomes of osteotomy around the knee.

Ding H, Koga H, Katagiri H, Hasegawa S, Anzai T, Katakura M Knee Surg Sports Traumatol Arthrosc. 2023; 31(12):5896-5904.

PMID: 37964126 DOI: 10.1007/s00167-023-07646-y.


Association of the Degree of Varus Thrust during Gait Assessed by an Inertial Measurement Unit with Patient-Reported Outcome Measures in Knee Osteoarthritis.

Misu S, Tanaka S, Miura J, Ishihara K, Asai T, Nishigami T Sensors (Basel). 2023; 23(10).

PMID: 37430491 PMC: 10224415. DOI: 10.3390/s23104578.

References
1.
Otsuki S, Okamoto Y, Ikeda K, Wakama H, Okayoshi T, Neo M . Perioperative duloxetine administration reduces pain after high tibial osteotomy and non-steroidal anti-inflammatory administration: A prospective, controlled study. Knee. 2022; 38:42-49. DOI: 10.1016/j.knee.2022.07.006. View

2.
Sterett W, Steadman J, Huang M, Matheny L, Briggs K . Chondral resurfacing and high tibial osteotomy in the varus knee: survivorship analysis. Am J Sports Med. 2010; 38(7):1420-4. DOI: 10.1177/0363546509360403. View

3.
Wylde V, Palmer S, Learmonth I, Dieppe P . The association between pre-operative pain sensitisation and chronic pain after knee replacement: an exploratory study. Osteoarthritis Cartilage. 2013; 21(9):1253-6. DOI: 10.1016/j.joca.2013.05.008. View

4.
Sabzevari S, Ebrahimpour A, Khalilipour Roudi M, Kachooei A . High Tibial Osteotomy: A Systematic Review and Current Concept. Arch Bone Jt Surg. 2016; 4(3):204-12. PMC: 4969364. View

5.
Scott C, Howie C, MacDonald D, Biant L . Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br. 2010; 92(9):1253-8. DOI: 10.1302/0301-620X.92B9.24394. View