Neuropathic pain-like symptoms and pre-surgery radiographic severity contribute to patient satisfaction 4.8 years post-total joint replacement

作     者：Sophie C Warner Helen Richardson Wendy Jenkins Thomas Kurien Michael Doherty Ana M Valdes 

作者机构：Academic RheumatologyUniversity of NottinghamClinical Sciences BuildingNottingham City Hospital Department of Cardiovascular SciencesUniversity of Leicester and National Institute for Health Res-earchLeicester Cardiovascular Biomedical Research Unit Arthritis Research UK Pain Centre Academic Division of Trauma and OrthopaedicsQueens Medical Centre 

出 版 物：《World Journal of Orthopedics》 (世界骨科杂志（英文版）)

年 卷 期：2017年第8卷第10期

页      面：761-769页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：Supported by PhD studentship awarded by the University of Nottingham(to Warner SC) EULAR project grant to AMV,No.108239 ARUK Pain Centre,No.18769 

主　　题：Osteoarthritis Patient satisfaction Total joint arthroplasty Neuropathic pain Surgery outcomes 

摘      要：AIM To investigate a comprehensive range of factors that contribute to long-term patient satisfaction post-total joint replacement(TJR) in people who had undergone knee or hip replacement for *** Participants(n = 1151) were recruited from Nottinghamshire post-total hip or knee replacement. Questionnaire assessment included medication use, the pain-DETECT questionnaire(PDQ) to assess neuropathic pain-like symptoms(NP) and TJR satisfaction measured on average 4.8 years post-TJR. Individual factors were tested for an association with post-TJR satisfaction, before incorporating all factors into a full model. Data reduction was carried out using LASSO and receiveroperator characteristic(ROC) curve analysis was used to quantify the contribution of variables to post-TJR *** After data reduction, the best fitting model for post-TJR satisfaction included various measures of pain, history of revision surgery, smoking, pre-surgical X-ray severity, WOMAC function scores and various comorbidities. ROC analysis of this model gave AUC = 0.83(95%CI: 0.80-0.85). PDQ scores were found to capture much of the variation in post-TJR satisfaction outcomes: AUC = 0.79(0.75-0.82). Pre-surgical radiographic severity was associated with higher post-TJR satisfaction: OR_(satisfied) = 2.06(95%CI: 1.15-3.69), P = *** These results highlight the importance of pre-surgical radiographic severity, post-TJR function, analgesic medication use and NP in terms of post-TJR satisfaction. The PDQ appears to be a useful tool in capturing factors that contribute to post-TJR satisfaction.