TOTAL DİZ ARTROPLASTİSİ SONRASI AKUT POSTOPERATİF AĞRI VE FİZİKSEL FONKSİYON ÜZERİNDE PREOPERATİF FAKTÖRLERİN ROLÜ

Abstract

Amaç: Total Diz Artroplastisi (TDA) sonrası akut dönemde bildirilen ağrı yakınmalarını ve fiziksel fonksiyonu etkileyebilecek preoperatif faktörler mevcuttur. Bu çalışma, TDA sonrası hastaların akut dönemde ağrı ve fiziksel fonksiyonuna etki edebilecek preoperatif faktörleri ortaya çıkarmak amacıyla planlandı. Yöntem: Çalışmaya yaş ortalamaları 66,5 ± 7,53 olan 70 hasta (53 kadın, 17 erkek) dahil edildi. Ameliyat öncesi hastaları değerlendirmek için Hospital for Special Surgery Diz Skorlaması, Vizüel Analog Skalası, Tampa Kinezyofobi Ölçeği, Hastane Anksiyete ve Depresyon Ölçeği, Uluslararası Fiziksel Aktivite Anketi Kısa Formu ve Vücut Farkındalığı Anketi kullanıldı. Ameliyat sonrası değerlendirmeler için Kısa Ağrı Anketi ve Süreli Kalk ve Yürü Testi kullanıldı. Sonuçlar: Postoperatif akut ağrı (PAA), preoperatif kinezyofobi, anksiyete, depresyon ve ağrı şiddeti ile ilişkili bulunurken (r=0,684, p=0,000; r=0,424, p=0,000; r=0,329, p=0,005; r=0,259, p=0,030, sırasıyla) postoperatif akut fiziksel performans (PAFP) preoperatif kinezyofobi ile ilişkili bulunmuştur (r=0,280, p=0,019). Preoperatif vücut farkındalığı ile PAA ve PAFP ile ilişkili olmadığı bulunmuştur (p>0,05). Preoperatif fiziksel aktivite düzeyi inaktif olanlar ile inaktif olmayanlar arasında PAFP açısından anlamlı fark bulunmuştur (p=0,000). Ameliyat öncesi diz ağrısı süresi 5 yıl ve altında olan hastalar ile 6 yıl ve üzerinde olan hastalar arasında PAA ve PAFP arasında istatistiksel olarak anlamlı bir fark bulunmuştur (p=0,025). Tartışma: Bu çalışmada tanımlanan preoperatif risk faktörlerinin değerlendirilmesi yoluyla akut postoperatif ağrı ve kötü fiziksel performans riski daha yüksek olan hastalar belirlenebilir.

Keywords

• Akut Ağrı
• Diz Artroplastisi
• Fiziksel Fonksiyon
• Preoperatif Tahmin Edici
• İyileşme

THE ROLE OF PREOPERATIVE FACTORS ON ACUTE POSTOPERATIVE PAIN AND PHYSICAL FUNCTION AFTER TOTAL KNEE ARTHROPLASTY

Abstract

Purpose: Many preoperative factors can affect the pain and physical function complaints reported in the acute period after total knee arthroplasty (TKA). This study was planned to reveal the preoperative factors that may affect pain and physical function in the acute period of patients post-TKA. Methods: Seventy patients (53 women, 17 men) with a mean age of 66.5±7.53 years were enrolled in this study. Before the surgery, the Hospital for Special Surgery Knee Scoring, a Visual Analog Scale, the Tampa Kinesiophobia Scale, the Hospital Anxiety and Depression Scale, the International Physical Activity Questionnaire Short Form and the Body Awareness Questionnaire were used to evaluate the patients. The Brief Pain Inventory and the Timed Up and Go Test were used for post-surgery assessments. Results: Postoperative acute pain (PAP) was associated with preoperative kinesiophobia, anxiety, depression, and pain severity (r=0.684, p=0.000; r=0.424, p=0.000; r=0.329, p=0.005; r=0.259, p=0.030, respectively). Postoperative acute physical performance (PAPP) was associated with preoperative kinesiophobia (r=0.280 ; p=0.019). It was found that there was no relationship between preoperative body awareness and acute postoperative pain and physical performance (p>0.05). There was a significant difference in PAPP between inactive and inactive preoperative physical activity levels (p=0.000). There was a statistically significant difference between the PAP and PAPP between patients with preoperative knee pain duration of 5 years and under and patients with 6 years or more (p=0.025). Conclusion: Through the assessment of the preoperative risk factors identified in this study, patients at higher risk of acute postoperative pain and poor physical performance can be identified.

Keywords

• Acute Pain
• Knee Arthroplasty
• Physical Function
• Preoperative Predictor
• Recovery

References

1. Ditton E, Johnson S, Hodyl N, Flynn T, Pollack, M, Ribbons K, Nilsson M. Improving patient outcomes following total knee arthroplasty: identifying rehabilitation pathways based on modifiable psychological risk and resilience factors. Front. Psychol. 2020; 11: 1061.
2. Baker P, Rushton S, Jameson S, Reed M, Gregg P, Deehan D. Patient satisfaction with total knee replacement cannot be predicted from pre-operative variables alone: a cohort study from the National Joint Registry for England and Wales.Bone Joint J. 2013;95(10):1359-65.
3. Gilron I, Henrik Kehlet M. Prevention of chronic pain after surgery: new insights for future research and patient care. Can J Anesth.2014;61(2):101.
4. Khan M, Osman K, Green G, Haddad F. The epidemiology of failure in total knee arthroplasty: avoiding your next revision. Bone Joint J. 2016; 98 :105-12.
5. Høvik LH, Winther SB, Foss OA, Gjeilo KH. Preoperative pain catastrophizing and postoperative pain after total knee arthroplasty: a prospective cohort study with one year follow-up. BMC Musculoskelet. Disord. 2016;17 (1):1-7.
6. Thomazeau J, Rouquette A, Martinez V, Rabuel C, Prince N, Laplanche JL, Lloret‐Linares C. Acute pain factors predictive of post‐operative pain and opioid requirement in multimodal analgesia following knee replacement. Eur J Pain. 2016; 20 (5): 822-832.
7. Lewis, GN, Rice, DA, McNair, PJ ve Kluger, M. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. British journal of anaesthesia. 2015; 114 (4): 551-561.
8. Jette DU, Hunter SJ, Burkett L, Langham B, Logerstedt DS, Piuzzi NS. Physical therapist management of total knee arthroplasty. Physical therapy. 2020; 100 (9): 1603-1631.

9. Hernández C, Díaz-Heredia J, Berraquero ML, Crespo P, Loza E, Ibán MÁR. Pre-operative predictive factors of post-operative pain in patients with hip or knee arthroplasty: a systematic review. Reumatología Clínica (English Edition). 2015;11(6):361-80.
10. Robbins SM, Rastogi R, McLaughlin T-L. Predicting acute recovery of physical function following total knee joint arthroplasty. The Journal of arthroplasty. 2014;29(2):299-303.
11. Lindberg MF, Miaskowski C, Rustøen T, Rosseland LA, Paul SM, Cooper BA, et al. The impact of demographic, clinical, symptom and psychological characteristics on the trajectories of acute postoperative pain after total knee arthroplasty. Pain Medicine. 2017;18(1):124-39.
12. Springborg AH, Visby L, Kehlet H, Foss NB. Psychological predictors of acute postoperative pain after total knee and hip arthroplasty: A systematic review. Acta Anaesthesiologica Scandinavica. 2023; 67(10): 1322-1337. 13. Lungu E, Vendittoli P, Desmeules F. Preoperative determinants of patient-reported pain and physical function levels following total knee arthroplasty: a systematic review. The open orthopaedics journal. 2016; 10:213.
13. Rooks DS, Huang J, Bierbaum BE, Bolus SA, Rubano J, Connolly CE, et al. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Care & Research. 2006;55(5):700-8.
14. Pinto PR, McIntyre T, Ferrero R, Almeida A, Araújo-Soares V. Predictors of acute postsurgical pain and anxiety following primary total hip and knee arthroplasty. The Journal of Pain. 2013;14(5):502-15.
15. Sarac DC, Unver B & Karatosun V. Validity and reliability of performance tests as balance measures in patients with total knee arthroplasty. Knee Surg Relat Res. 2022; 34(1): 1-7.
16. Narin S, Unver B, Bakirhan S, Bozan O, Karatosun V. Cross-cultural adaptation, reliability and validity of the Turkish version of the Hospital for Special Surgery (HSS) Knee Score. Acta Orthop Traumatol Turc. 2014;48(3):241-8.
17. Waterfield J, Sim J. Clinical assessment of pain by the visual analogue scale. British Journal of Therapy and Rehabilitation. 1996;3(2):94-7.
18. Boeckstyns ME, Backer M. Reliability and validity of the evaluation of pain in patients with total knee replacement. Pain. 1989;38(1):29-33.
19. Yilmaz ÖT, Yakut Y, Uygur F, Uluğ N. Tampa Kinezyofobi Ölçeği’nin Türkçe versiyonu ve test-tekrar test güvenirliği. Fizyoterapi Rehabilitasyon. 2011;22(1):44-9.
20. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta psychiatrica scandinavica. 1983;67(6):361-70.
21. Aydemir Ö, Guvenir T, Kuey L, Kultur S. Validity and reliability of Turkish version of hospital anxiety and depression scale. Turk Psikiyatri Dergisi. 1997;8(4):280-7.
22. Gay C, Guiguet-Auclair C, Mourgue C, Gerbaud L, & Coudeyre E. Physical activity level and association with behavioral factors in knee osteoarthritis. Ann. Phys. Rehabil. Med. 2019; 62 (1):14-20.
23. Karabıyık S. Akut aerobik egzersizin fiziksel inaktif ve çok aktif lise çağı öğrencilerinin duygu durumlarına etkisi (Yüksek Lisans Tezi): Dokuz Eylül Üniversitesi (Turkey); 2018.
24. Saglam M, Arikan H, Savci S, Inal-Ince D, Bosnak-Guclu M, Karabulut E, et al. International physical activity questionnaire: reliability and validity of the Turkish version. Perceptual and Motor Skills. 2010;111(1):278-84.
25. Karaca S, Bayar B. Turkish version of body awareness questionnaire: validity and reliability study. Turk J Physiother Rehabil. 2021;32(1):44-50.
26. Poquet N, & Lin C. The brief pain inventory (BPI). J. Physiother. 2015; 62(1): 52-52.
27. Dicle A, Karayurt Ö, Dirimese E. Validation of the Turkish version of the Brief Pain Inventory in surgery patients. Pain Management Nursing. 2009;10(2):107-13. e2.
28. Unver B, Kalkan S, Yuksel E, Kahraman T, Karatosun V. Reliability of the 50-foot walk test and 30-sec chair stand test in total knee arthroplasty. Acta ortopedica brasileira. 2015; 23:184-7.
29. Yuksel E, Kalkan, S., Cekmece, S., Unver, B., & Karatosun, V. Assessing minimal detectable changes and test-retest reliability of the timed up and go test and the 2-minute walk test in patients with total knee arthroplasty. The Journal of Arthroplasty. 2017; 32(2):426-430.
30. Cohen J. Statistical power analysis for the behavioral sciences. Routledge. 2013.
31. Calatayud J, Casaña J, Ezzatvar Y, Jakobsen MD, Sundstrup E, Andersen LL. High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017;25:2864-72.
32. Filardo G, Merli G, Roffi A, Marcacci T, Berti Ceroni F, Raboni D. Kinesiophobia and depression affect total knee arthroplasty outcome in a multivariate analysis of psychological and physical factors on 200 patients. Knee Surg Sports Traumatol Arthrosc. 2017; 25(11): 3417-23.
33. Taniguchi M, Sawano S, Kugo M, Maegawa S, Kawasaki T, Ichihashi N. Physical activity promotes gait improvement in patients with total knee arthroplasty. J. Arthroplasty. 2016; 31(5): 984-8.
34. Michaelides A, & Zis P. Depression, anxiety and acute pain: links and management challenges. Postgrad. Med. 2019; 131(7): 438-444.
35. Sorel JC, Veltman ES, Honig A, & Poolman RW. The influence of preoperative psychological distress on pain and function after total knee arthroplasty: a systematic review and meta-analysis. Bone Joint J. 2019; 101(1): 7-14.
36. Erden A, Altug, F, & Cavlak U. Investigation of the relationship between body awareness, pain, emotional status, and quality of life among healthy people. J Kartal Train Res Hosp. 2013; 24(3): 145-150.
37. Mehling WE, Gopisetty V, Daubenmier J, Price CJ, Hecht FM, Stewart A. Body awareness: construct and self-report measures. PloS one. 2009;4(5): e5614.
38. Dash SK, Palo N, Arora G, Chandel SS, Kumar M. Effects of preoperative walking ability and patient's surgical education on quality of life and functional outcomes after total knee arthroplasty. Revista Brasileira de Ortopedia. 2017; 52: 435-41.
39. Çankaya D, Yılmaz S, Deveci A, Daşar U, Ceyhan E, Kılıç E. Total diz artroplastisi sonrası komplikasyon oranlarını etkileyen sosyal ve demografik faktörler. Uluslararası Klinik Araştırmalar Dergisi. 2014;2(4):138-42.