Can Neuropathic Pain Predict Response to Arthroplasty in Knee Osteoarthritis? A Prospective Observational Cohort Study

A significant proportion of patients with knee osteoarthritis (OA) continue to have severe ongoing pain following knee replacement surgery. Central sensitization and features suggestive of neuropathic pain before surgery may result in a poor outcome post-operatively. In this prospective observational study of patients undergoing primary knee arthroplasty (n=120), the modified PainDETECT score was used to divide patients, with primary knee OA, into nociceptive (18) groups pre-operatively. Response to surgery was compared between groups using the Oxford Knee Score (OKS) and the presence of moderate to severe long-term pain 12 months after arthroplasty. The analyses were replicated in a larger independent cohort study (n=404). 120 patients were recruited to the main study cohort: 63 (52%) nociceptive pain; 32 (27%) unclear pain; 25 (21%) neuropathic-like pain. Patients with neuropathic-like pain had significantly worse OKS pre and post-operatively, compared to the nociceptive pain group, independent of age, sex and BMI. At 12-months post-operatively the mean OKS was 4 points lower in the neuropathic-like group compared with the nociceptive group in the study cohort (non-significant); with a difference of 5 points in the replication cohort (p<0.001). Moderate to severe long-term pain after arthroplasty at 12-months was present in 50% of the neuropathic-like pain group versus 24% in the nociceptive pain group, in the replication cohort (p<0.001). Neuropathic pain is common and targeted therapy pre, peri and post-operatively may improve treatment response.