• V Wylde, S Palmer, I D Learmonth, and P Dieppe.
• Musculoskeletal Research Unit, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK. V.Wylde@bristol.ac.uk
• Osteoarthr. Cartil. 2013 Sep 1;21(9):1253-6.

ObjectiveChronic pain after total knee replacement (TKR) is a prevalent condition, affecting about 20% of patients. The aim of this study was to explore the relationship between pre-operative pain thresholds and chronic pain after TKR.DesignPatients listed for a TKR because of osteoarthritis participated in a Quantitative Sensory Testing (QST) session prior to surgery. Pressure pain thresholds (PPTs) and hot pain thresholds were assessed at the osteoarthritic knee and the forearm. Patients were followed-up at 1-year after TKR, and the severity of pain in the replaced knee was assessed using the WOMAC Pain score. Pre-operative median QST thresholds were compared to thresholds from a normative database collected from 50 people with no knee pain. The relationship between pre-operative pain thresholds and pain severity post TKR were tested using correlations.ResultsFifty-one patients participated in a pre-operative QST session and completed a 1-year WOMAC Pain score. Pre-operatively, patients demonstrated evidence of localised (knee) and widespread (forearm) pain sensitisation in response to pressure stimuli compared to healthy participants. Pre-operative PPTs at the forearm were found to be significantly correlated with 1-year WOMAC Pain scores (r = 0.37, P = 0.008).ConclusionsThis study provides preliminary evidence that pre-operative widespread pain sensitisation, measured using pressure algometry, may be associated with chronic pain after TKR. Further research is needed to explore the predictive value of an assessment of pre-operative widespread pain sensitisation in identifying who is likely to develop chronic pain after TKR.Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

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