Early Postoperative Pain After Total Knee Arthroplasty Is Associated With Subsequent Poorer Functional Outcomes and Lower Satisfaction.

BACKGROUND: There are few studies investigating the effects of acute postoperative pain on functional outcomes after total knee arthroplasty (TKA). The aims of this study are to identify perioperative factors associated with increased early postoperative pain and investigate the effects of acute postoperative day 1 and 2 pain on outcomes at 6 months and 2 years post-TKA. METHODS: 1041 unilateral TKA patients were included in this retrospective cohort study. Patients were categorized into minor (visual analog scale: VAS <5) and major (VAS ≥5) pain groups based on postoperative day 1/2 VAS scores. Patients were assessed preoperatively, at 6 months and 2 years using Knee Society Knee Score and Function Scores (KSFS), Oxford Knee Score (OKS), SF-36 physical and mental component score (SF-36 PCS), expectation and satisfaction scores. Perioperative variables including age, gender, race, body mass index, American Society of Anesthesiologist status, type of anesthesia, and presence of caregiver were analyzed as predictors of postoperative acute pain. Wilcoxon two-sample test was used to analyze outcomes significantly associated with "major pain." Multiple logistic regression was used to identify predictors of "major pain." RESULTS: Patients with "minor pain" had significantly better KSFS, Knee Society Knee Score, OKS, and SF-36 PCS scores at 6 months and significantly better KSFS, OKS, SF-36 PCS, and satisfaction at 2 years (P < .05). A significantly higher percentage of patients with "minor pain" met the minimal clinically important difference for SF-36 PCS at 6 months and KSFS at 2 years (P < .05). Women, Indian/Malay race, higher BMI, and use of general over regional anesthesia were independent predictors of getting "major pain" (P < .05). CONCLUSION: Patients should be counseled about risk factors of postoperative pain to manage preoperative expectations of surgery. Patients should be managed adequately using multimodal pain protocols to improve subsequent functional outcomes while avoiding unnecessary opioid use.

Early postoperative straight leg raise is associated with shorter length of stay after unilateral total knee arthroplasty.

PURPOSE: Shorter length of stay (LOS) after total knee arthroplasty (TKA) is cost-effective. Straight leg raise (SLR) is a common exercise prescribed after TKA, but the significance of early postoperative SLR is unknown. The primary aim of this study is to evaluate the association between early postoperative SLR and LOS. Secondary aims are to explore associations among early postoperative SLR, time to ambulation, and time to stairs climbing and identify factors related to postoperative SLR. METHODS: 888 TKAs (888 knees, 865 patients) performed at a tertiary hospital in 2016 were included for this retrospective study. All TKAs were performed with medial parapatellar approach and tourniquet. Time to events (SLR, ambulation, stair climbing), LOS and factors influencing these events were analysed using a multivariate Poisson regression model and logistic regression. RESULTS: Patients who performed SLR on postoperative day 1 (POD1) had shorter LOS than those who did not (adjusted Mean Ratio (aMR) = 0.846, p < 0.001), with estimated mean LOS being 3.5 days and 4.1 days, respectively. Performing SLR on POD1 was also associated with shorter time to ambulation (aMR = 0.789; p < 0.001) and stair climbing (aMR = 0.811, p < 0.001). Female gender and higher rest pain on POD1 were associated with delayed postoperative SLR. CONCLUSION: Performing SLR on POD1 after TKA is associated with shorter LOS, time to ambulation, and time to stair climbing. Early postoperative SLR can prognosticate early recovery and discharge. Optimization of preoperative muscle strength and postoperative pain may be important in early recovery after TKA.

Ballroom dance for persons with multiple sclerosis: a pilot feasibility study.

Purpose: The purpose of this study was to evaluate the exercise intensity and feasibility of recreational ballroom dance for persons with multiple sclerosis (MS).Methods: Seven persons with MS participated in 2 one-hour dance sessions per week for 6 weeks. Dance types included rumba, foxtrot, waltz, and push-pull. Six other persons with MS comprised a control group that did not dance. Heart rate and ratings of perceived exertion (RPE) were monitored during the sessions. Outcomes included: quality of life, fatigue, depression, self-efficacy, timed up and go, Berg Balance Scale, Dynamic Gait Index and the Multiple Sclerosis Functional Composite comprising 9-hole peg test, 25-ft walk test, and Paced Auditory Serial Addition Test (PASAT), a cognitive test.Results: Heart rates and RPE indicated that ballroom dance for persons with MS can provide a light to moderate exercise intensity. After the dance program, quality of life and PASAT improved as did the MS Functional Composite Score. No changes were noted in the control group.Conclusions: Recreational ballroom dance is feasible and can provide an exercise stimulus sufficient to help meet exercise recommendations for persons with multiple sclerosis as well as improve quality of life and cognition in persons with MS.Implications for rehabilitationExercise or physical activity is important for the health and wellness of persons with multiple sclerosis.Persons with multiple sclerosis often seek information about non-traditional low-impact physical activity.In a small controlled sample, partnered recreational ballroom or social dance for persons with multiple sclerosis has been shown to be feasible and of recommended exercise intensity.Further, partnered recreational ballroom dance for persons with multiple sclerosis can improve measures of quality of life and cognitive function.