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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald


CiteScore 2018: 0.85

SCImago Journal Rank (SJR) 2018: 0.494
Source Normalized Impact per Paper (SNIP) 2018: 0.427

Online
ISSN
1877-8879
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Volume 16, Issue 1

Issues

Preoperative synovitis in knee osteoarthritis is predictive for pain 1 year after total knee arthroplasty

Jonathan Vela
  • Department of Rheumatology, Aalborg, Denmark
  • Centre for Sensory-Motor Interaction, Aalborg, Denmark
  • Department of Mathematical Sciences, Aalborg, Denmark
  • Department of Orthopaedic Surgery, Aalborg, Denmark
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Kristian Kjær Petersen
  • Department of Rheumatology, Aalborg, Denmark
  • Centre for Sensory-Motor Interaction, Aalborg, Denmark
  • Department of Mathematical Sciences, Aalborg, Denmark
  • Department of Orthopaedic Surgery, Aalborg, Denmark
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Lars Arendt-Nielsen
  • Department of Rheumatology, Aalborg, Denmark
  • Centre for Sensory-Motor Interaction, Aalborg, Denmark
  • Department of Mathematical Sciences, Aalborg, Denmark
  • Department of Orthopaedic Surgery, Aalborg, Denmark
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Mikkel Meyer Andersen
  • Department of Rheumatology, Aalborg, Denmark
  • Centre for Sensory-Motor Interaction, Aalborg, Denmark
  • Department of Mathematical Sciences, Aalborg, Denmark
  • Department of Orthopaedic Surgery, Aalborg, Denmark
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Ole Simonsen
  • Department of Rheumatology, Aalborg, Denmark
  • Centre for Sensory-Motor Interaction, Aalborg, Denmark
  • Department of Mathematical Sciences, Aalborg, Denmark
  • Department of Orthopaedic Surgery, Aalborg, Denmark
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-07-01 | DOI: https://doi.org/10.1016/j.sjpain.2017.04.056

Abstract

Background

Knee osteoarthritis (KOA) was previously considered a degenerative joint disease due to wear and tear. After total Knee replacement (TKR) 13–38% of patients develop persistent post-operative pain. Emerging evidence has shown that the etiology of pain in KOA is multifaceted and may involve different structures including the synovial membrane, musculotendinous structures and neuronal tissue. Current preoperative assessment does not take these into account, thus the current study examines the role of preoperative synovitis on patient reported outcomes one-year post surgery.

Material and methods

40 patients with end-stage KOA answered the KOOS questionnaire prior to receiving total knee replacement surgery. During the procedure synovitis was scored systematically at six sites where synovial excision biopsies were obtained. Macro scoring was based on three parameters (hypertrophy, vascularity and synovitis) on a 0–4 point scale. Micro biopsies where also graded based on three parameters (synovial hyperplasia, inflammatory infiltration and activation of synovial stroma) but on a 0–3 point scale. Patients received a follow up KOOS questionnaire one-year post surgery.

Results

33 patients completed the KOOS questionnaire at follow-up. A high correlation between the micro mean, micro max, macro mean, and macro max was found. The micro mean was chosen as a proxy for the amount of synovitis. A multiple linear regression analysis, correcting for baseline values of BMI, age, smoking, point pressure thresholds (PPTs) and KOOS pain, showed that the synovitis measurement at baseline was significant for the change in KOOS pain with an effect of 22.22 (p = 0.0498). Hence, the more synovitis at baseline, the higher the follow-up KOOS Pain was compared to baseline KOOS Pain (an improvement). The standard deviation (SD) of the synovitis measure was 0.42, hence a change of 1 SD in synovitis gave an increase of 9 in KOOS Pain at follow-up compared to at baseline.

Conclusions

These preliminary results indicate that the synovitis score attained during operation is positively correlated with improvement in KOOS-pain post operatively.

About the article

Published Online: 2017-07-01

Published in Print: 2017-07-01


Citation Information: Scandinavian Journal of Pain, Volume 16, Issue 1, Pages 184–184, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2017.04.056.

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